Morton's interdigital neuroma: A clinical review of its etiology, treatment, and results

Wu, Kao

doi:10.1016/s1067-2516(96)80027-5

Cited by 154 publications

(96 citation statements)

References 24 publications

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“…As reported previously 2,4 , women were predominantly affected in our series and III-IV IDN was most common. typically, patients complain of a precisely localized pain between the affected metatarsal heads, which often radiates to the toes.…”

Section: Discussionsupporting

confidence: 85%

“…Although the clinical manifestations of Morton's neuroma are quite typical to physicians experienced in this area, objective confirmation of diagnosis is required for most patients because tts, distal sensory neuropathy, localized tendinitis, or arthritis can mimic IDN 2,4 . For this reason, the nerve conduction study, ultrasound, ct, and MrI scans have been used.…”

Section: Discussionmentioning

confidence: 99%

“…Morton's neuroma is one of the most common and most painful conditions to affect the metatarsal area 3 . Women are considerably more frequently affected than men, quite likely because of wearing high-heeled and pointed-toe shoes 2,4 . repeated trauma on the interdigital nerve between the heads of the metatarsals is the most commonly accepted cause of this disorder.…”

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confidence: 99%

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Abnormal dip phenomenon: a characteristic electrophysiological marker in interdigital neuropathy of the foot

Almeida

Kurokawa

Hatanaka

et al. 2007

Arq. Neuro-Psiquiatr.

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-Objective: the nerve conduction findings in interdigital neuropathy of the foot (IDN; Morton's neuroma) have rarely been reported. We analyzed the nerve conduction data in 23 patients with suspected IDN studied between 1982 and 2002. Method: Diagnosis of IDN was made on the basis of clinical features. All patients underwent routine nerve conduction studies and a near-nerve needle sensory nerve conduction study of the interdigital nerves by Oh's method in the symptomatic foot. Results: Of the 23 patients, the diagnosis of definite IDN was made in 13 cases and of possible NDN in the others cases. Nineteen were females. twenty two patients had only one nerve affected. One patient had two nerves affected. the III-IV interdigital nerve was affected in 17 cases and the II-III interdigital nerve in 7 cases. the near-nerve needle nerve conduction showed abnormality in the affected interdigital nerves in all definite IDN cases and confirmed the diagnosis of IDN in 10 cases by the abnormal dip phenomenon (a selective decrease of 50% or more in the sensory cNAP amplitude of the affected nerve compared with that of the preceding interdigital nerve). In 11 possible IDN cases, IDN was identified by the abnormal dip phenomenon. Conclusion: the near-nerve needle sensory nerve conduction of the interdigital nerves is a highly sensitive diagnostic test, and abnormal dip phenomenon is the most characteristic electrophysiological marker for the diagnosis of IDN.Key WOrDs: Morton's neuroma, metatarsalgia, interdigital neuropathy, nerve conduction.Fenômeno da diminuição de amplitude anormal: um marcador eletrofisiológico característico da neuropatia interdigital do pé resuMO -Objetivo: Os achados da condução nervosa na neuropatia interdigital do pé (NIP) têm sido raramente descritos. Nós analisamos os dados da condução nervosa de 23 pacientes com suspeita de NIP entre 1982 e 2002. Método: O diagnóstico de NIP foi clínico. todos os pacientes foram submetidos a estudos de condução nervosa de rotina e ao estudo de condução sensitiva dos nervos interdigitais com agulha justa-neural pelo método de Oh. Resultados: Dos 23 pacientes, o diagnóstico de NIP foi definitivo em 13 casos é possível nos demais. Dezenove pacientes eram mulheres e 22 tinham somente um nervo afetado. Apenas um paciente teve dois nervos comprometidos. O nervo interdigital III-IV foi afetado em 17 casos e o nervo interdigital II-III em 7 casos. A condução nervosa justa-neural foi anormal nos nervos interdigitais acometidos em todos os casos definitivos e confirmou o diagnóstico de neuropatia interdigital em 10 casos pelo fenômeno da diminuição de amplitude anormal (uma diminuição seletiva de 50% ou mais da amplitude do PANs do nervo afetado quando comparado com o nervo anterior. em 11 casos possíveis, a neuropatia interdigital foi identificada pelo fenômeno da diminuição de amplitude anormal. Conclusão: A condução nervosa sensitiva justa-neural dos nervos interdigitais do pé é um teste diagnóstico altamente sensível e o fenômeno da diminuição da amplitude anorm...

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Abnormal dip phenomenon: a characteristic electrophysiological marker in interdigital neuropathy of the foot

Almeida

Kurokawa

Hatanaka

et al. 2007

Arq. Neuro-Psiquiatr.

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“…While the exact cause of PDN remains unclear, [5][6][7] it is most likely a mechanically induced neuropathy 5,[8][9][10][11] caused by entrapment of the nerve as it passes inferiorly to the transverse inter-metatarsal ligament (IML). 7,[11][12][13] The clinical presentation, positive clinical tests, and a good history are usually sufficient to make an accurate diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

Cashley

Cochrane

2015

Journal of Chiropractic Medicine

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Objective: The purpose of this retrospective case series is to describe treatment outcomes for patients with plantar digital neuralgia (PDN) (Morton's neuroma) who were treated using foot manipulation. Methods: Charts were reviewed retrospectively for patients with a diagnosis of PDN and who received a minimum of 6 treatments consisting of manipulation alone. Visual analogue pain scales (VAS) and pressure threshold meter readings (PTM) were extracted as outcome measures. Results: Thirty-eight cases met inclusion criteria. Mean pretreatment duration of pain was 28 months. Mean pretreatment VAS was 69.5/100 mm. Mean pretreatment PTM was 2.54 Kp. By the sixth treatment, 30 (79%) of the 38 patients scored a VAS of 0 mm and a further 4 (10%) were below 10 mm. Contralateral limb PTM showed a mean pre-treatment score of 5.5 Kp, which rose slightly to 5.85 Kp. This compared to a pre-treatment score of 2.54 Kp rising to 5.86 Kp in the affected limb. This represents a 126% increase in the affected side compared to 6.5% in the unaffected limb. Statistical analysis demonstrated a significant linear trend between decreasing VAS and manipulation (P b .001). Conclusion: The patients with PDN who were included in this case series improved with conservative care that included only foot manipulation.

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“…These include inflammation of the interdigital nerve [6], digital artery occlusion causing nerve ischaemia [7], entrapment at the edge of the transverse intermetatarsal ligament [8] and compression of the nerve via swollen bursae [9]. Another causative factor, which also explains that the increased incidence of Morton's neuroma in middle-aged females is the use of high-heeled, narrow-pointed shoes, which cause an increase in pressure on the forefoot, hyperextension of themetatarsophalangeal joints and force the metatarsal heads together, resulting in the compression of the interdigital nerves against the transverse metatarsal ligament and adjacent metatarsal heads [10]. It is believed that many of these factors could be the cause of the characteristic pain associated with Morton's Neuroma, however it is more likely a combination of these factors are acting together.…”

Section: Introductionmentioning

confidence: 99%

Does Greek Foot Predispose to Morton’s Neuroma?

Jump¹,

Rice²,

Gheorghiu³

et al. 2014

OJO

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Background: Morton's neuroma is the enlargement of an interdigital nerve most commonly located between the third and fourth metatarsals. Greek foot is a normal variant where the first metatarsal is shorter than the second metatarsal. To our knowledge, there is currently no reported association between Greek foot and Morton's neuroma in the literature. Methods: Retrospective study of 184 patients. Two separate cohorts were recruited. Cohort A comprised of 100 randomly selected asymptomatic patients. Cohort B comprised of 84 patients with a history of foot pain and histologically confirmed Morton's neuroma. Foot shape was determined by using a selfassessment tool and plain radiographs. Statistical analyses were performed using the Chi-square test on the association between Greek foot and Morton's neuroma. A p-value of <0.05 was considered statistically significant. Results: Our study shows a statistically significant association between Greek foot and Morton's neuroma with a prevalence of Greek foot in Cohort A of 20% and in Cohort B of 63%. (p = 2.6 × 10 −9 ). Conclusions: This study has shown a possible association between the presence of a Greek foot and the presence of Morton's neuroma. Although our study design has limitations and does not allow full statistical analysis, we do believe that the shown association between Greek foot and Morton's neuroma can help clinicians and other health care providers in establishing the diagnosis of Morton's neuroma in patients with a painful foot.

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Morton's interdigital neuroma: A clinical review of its etiology, treatment, and results

Cited by 154 publications

References 24 publications

Abnormal dip phenomenon: a characteristic electrophysiological marker in interdigital neuropathy of the foot

Abnormal dip phenomenon: a characteristic electrophysiological marker in interdigital neuropathy of the foot

Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

Does Greek Foot Predispose to Morton’s Neuroma?

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