Morton??s Metatarsalgia due to Intermetatarsophalangeal Bursitis as an Early Manifestation of Rheumatoid Arthritis

Awerbuch, Mark; Shephard, Edmund; Vernon‐Roberts, B.

doi:10.1097/00003086-198207000-00033

Cited by 43 publications

(22 citation statements)

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“…Recurrent local impingement of the nerve underneath this ligament, with subsequent nerve structure degeneration and perineural fibrosis, is the most commonly accepted cause of Morton neuroma (interdigital neuritis) (27). Other possible causes include ischemia and compression of the interdigital nerve by an inflamed and enlarged intermetatarsal bursa (28). The main symptoms of Morton neuroma are pain in the forefoot with numbness and paresthesia in the adjacent toes.…”

Section: Intermetatarsal Spacesmentioning

confidence: 99%

US of Nerve Entrapments in Osteofibrous Tunnels of the Upper and Lower Limbs

et al. 2000

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The diagnosis of nerve entrapment at osteofibrous tunnels relies primarily on clinical and electrodiagnostic findings. Recently, the refinement of high-frequency broadband transducers with a range of 5-15 MHz, sophisticated focusing in the near field, and sensitive color and power Doppler technology have improved the ability to evaluate peripheral nerve entrapment in osteofibrous tunnels with ultrasonography (US). In the upper limb, osteofibrous tunnels amenable to US examination include the carpal tunnel for the median nerve and the cubital and Guyon tunnels for the ulnar nerve. In the lower limb, these tunnels include the fibular neck for the common peroneal nerve, the tarsal tunnel for the posterior tibial nerve, and the intermetatarsal spaces for the interdigital nerves. High-resolution US allows direct imaging of the involved nerves, as well as documentation of changes in nerve shape and echotexture that occur in compressive syndromes. A spectrum of extrinsic causes of entrapment, such as tenosynovitis, ganglia, soft-tissue tumors, bone and joint abnormalities, and anomalous muscles, can also be diagnosed with US. With continued experience, it is likely that this technique will be increasingly used to evaluate nerve entrapment syndromes.

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Section: Intermetatarsal Spacesmentioning

confidence: 99%

US of Nerve Entrapments in Osteofibrous Tunnels of the Upper and Lower Limbs

et al. 2000

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“…The clinical syndrome of Morton’s neuroma was described over a century ago, but its etiopathology remains poorly understood [1, 8, 9]. Recent studies suggest that Morton’s neuroma is a mechanically induced degenerative neuropathy which has a strong predilection for the third common digital nerve [10].…”

Section: Introductionmentioning

confidence: 99%

“…Rheumatoid synovitis and nodules producing symptoms mimicking Morton’s neuroma have been reported in the literature [1, 3, 9], but are still rare. Most of the cases reported in the literature were found in rheumatoid arthritis patients [1, 7, 9].…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid nodule presenting as Morton’s neuroma

Chaganti

Joshy

Hariharan

et al. 2012

J Orthopaed Traumatol

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Among 101 feet that presented with symptoms and signs similar to Morton’s neuroma, intermetatarsal rheumatoid nodules were found in five feet (three patients). Two patients had bilateral involvement. Histology of the excised tissue showed the presence of a rheumatoid nodule and Morton’s neuroma in four feet and a rheumatoid nodule with unremarkable nerve bundles in one. A rheumatoid nodule can coexist with Morton’s neuroma, as seen in our patients, and the presentation is often similar to that of a Morton’s neuroma. Our patients were rendered asymptomatic with surgical treatment and went on to have appropriate management of rheumatoid arthritis. Rheumatoid nodule should be considered in the differential diagnosis of Morton’s neuroma in not only rheumatoid arthritis patients but also asymptomatic patients who have never been tested for rheumatoid antibodies.

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“…6,23 A strong association exists between MN and rheumatoid arthritis, and it has been proposed that an inflamed or swollen intermetatarsal bursa, due to rheumatoid arthritis or some other inflammatory state, compresses or irritates the nerve. 2,28 However, some authors report that inflammatory changes are rare or absent in their material. 14,24 Obliterative vascular changes may also contribute to the pathophysiology, by causing ischemia with subsequent injury to the nerve.…”

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confidence: 97%