Morton’s neuroma – Current concepts review

Bhatia, Maneesh; Thomson, Lauren

doi:10.1016/j.jcot.2020.03.024

Cited by 34 publications

(29 citation statements)

References 48 publications

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“…Both conservative and surgical means of treatment have been recommended for the treatment of intermetatarsal/ interdigital entrapment, which remains somewhat controversial. Multiple studies have been conducted to ascertain the effectiveness of non-surgical versus surgical treatment of this condition [1,3,7]. Many studies have demonstrated improvement in symptoms over 80% with surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

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Considerations in the Diagnosis and Treatment of Morton’s Entrapment: A Review

2020

Integr J Orthop Traumatol

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Section: Discussionmentioning

confidence: 99%

“…Surgical treatment varies from entrapment release to full neurectomy [2]. Post-operative pathology review of neurectomized tissue rarely demonstrates axonal degeneration and collagen proliferation [3]. Those changes are the pathophysiological markers associated with nerve injury that lead to true neuroma formation.…”

Section: Introductionmentioning

confidence: 99%

Considerations in the Diagnosis and Treatment of Morton’s Entrapment: A Review

2020

Integr J Orthop Traumatol

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“…Patients with MN present with significant burning or sharp metatarsalgia either on the plantar or dorsal side of the foot, which can be associated with numbness of the toes. Interestingly, it can also been found in 30% of asymptomatic volunteers ( 6 ) and 17% of patients can associate the onset of symptoms with forefoot trauma ( 7 ) . Pain is elicited during weight-bearing in cases where the respective IMS is loaded, particularly during activities which involve walking and running, as well as when wearing high-heeled shoes ( 7 , 8 ) .…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, it can also been found in 30% of asymptomatic volunteers ( 6 ) and 17% of patients can associate the onset of symptoms with forefoot trauma ( 7 ) . Pain is elicited during weight-bearing in cases where the respective IMS is loaded, particularly during activities which involve walking and running, as well as when wearing high-heeled shoes ( 7 , 8 ) . History and clinical examination can raise the suspicion of MN.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided treatment of Morton’s neuroma

et al. 2021

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Morton’s neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular degeneration, and deregulation of sympathetic innervation. Patients usually present with burning or sharp metatarsalgia at the dorsal or plantar aspect of the foot. The management of Morton’s neuroma starts with conservative measures, usually with limited efficacy, including orthotics and anti-inflammatory medication. When conservative treatment fails, a series of minimally invasive ultrasound-guided procedures can be employed as second-line treatments prior to surgery. Such procedures include infiltration of the area with a corticosteroid and local anesthetic, chemical neurolysis with alcohol or radiofrequency thermal neurolysis. Ultrasound aids in the accurate diagnosis of Morton’s neuroma and guides the aforementioned treatment, so that significant and potentially long-lasting pain reduction can be achieved. In cases of initial treatment failure, the procedure can be repeated, usually leading to the complete remission of symptoms. Current data shows that minimally invasive treatments can significantly reduce the need for subsequent surgery in patients with persistent Morton’s neuroma unresponsive to conservative measures. The purpose of this review is to present current data on the application of ultrasound for the diagnosis and treatment of Morton’s neuroma, with emphasis on the outcomes of ultrasound-guided treatments.

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“…It is characterised by persistent painful swelling of common digital plantar nerve (CDPN), known as a "neuroma" [3][4][5]. This is actually a misnomer, as the lesion consists of a perineural fibrosis with no neoplastic tissue [6,7]. Tissue injury and forefoot pain exceeding 3 months could alter cerebral sensory processing and impair pain-inhibitory mechanisms, causing the development of chronic pain [8], resulting in a reduction of patient quality of life.…”

Section: Introductionmentioning

confidence: 99%

Fascial Manipulation Technique in the Conservative Management of Morton’s Syndrome: A Pilot Study

Biz

Stecco

Fantoni

et al. 2021

IJERPH

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Background and Objective: Morton’s syndrome (MS) is a common cause of neuropathic chronic forefoot pain, characterised by the development of a swelling of the common digital plantar nerve, whose aetiology is not fully known. There is currently no gold standard of treatment; nonoperative management commonly involves manual therapies, orthoses therapy and infiltrative techniques, while surgery is indicated after failure of conservative measures. The present preliminary study prospectively evaluates patients affected by MS treated by Fascial Manipulation technique (FM), a noninvasive manual therapy, focused on the release of the deep fascia, reducing its stiffness. Materials and Methods: Patients with clinical and sonographic diagnosis of MS with at least a 4-month history of neuropathic symptoms underwent a cycle of three weekly FM sessions. Clinical follow-up, including VAS and AOFAS scores, was performed 21 days (T1) and 3 months (T2) after treatment. Results: Nine patients, among 28 recruited initially, completed the manual therapy sessions and relative follow-up points. This noninvasive pain treatment led to significant improvement of VAS (p = 0.0034) and AOFAS scores (p = 0.0240) at the first follow-up (T1). At 3-month follow-up (T2), both scores decreased slightly, remaining however superior to the pre-treatment values. Only VAS was still significant (p = 0.0184). Conclusions: Despite the small size of the case series, this pilot study is unique in supporting Fascial Manipulation in the nonoperative treatment of MS. Further studies are needed with a large cohort of gender balanced patients to confirm the encouraging results obtained.

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Morton’s neuroma – Current concepts review

Cited by 34 publications

References 48 publications

Considerations in the Diagnosis and Treatment of Morton’s Entrapment: A Review

Considerations in the Diagnosis and Treatment of Morton’s Entrapment: A Review

Ultrasound-guided treatment of Morton’s neuroma

Fascial Manipulation Technique in the Conservative Management of Morton’s Syndrome: A Pilot Study

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