Morton's syndrome: surgical strategies according to the digital nerve pathology

Volpe, Antonio; Tognon, Sofia; Fassina, Ambrogio

doi:10.1046/j.1460-9584.1998.00096.x

Cited by 16 publications

(19 citation statements)

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“…Il continuo traumatismo determina un processo flogistico perineurale che induce proliferazione connettivale endo-perineurale e degenerazione ialina dell'endonevrio [1] con ingrossamento del nervo che alimenta il meccanismo di impin- The neuralgic metatarsalgia in Morton's syndrome should therefore be regarded as an impingement syndrome of the common digital nerve in the intermetatarsal space related to dorsal dislocation of the nerve between the metatarsal heads following plantar pressure and subsequent pinching between the heads themselves, associated in some cases with bursitis. The continuous trauma determines a perineural inflammatory process that induces endoperineural connective proliferation and hyaline degeneration of the endoneurium [1], with swelling of the nerve that feeds the impingement mechanism. This pathological entity is more commonly known as Morton's neuroma.…”

Section: Discussionementioning

confidence: 99%

“…Morton's syndrome is a neuralgic metatarsalgia caused by the common digital nerve becoming trapped in the metatarsal canal; the continued trauma brings about a perineural inflammatory process that in turn provokes endoperineural connective proliferation and hyaline degeneration of the endoneurium [1]. This pathological entity is more commonly known as Morton's neuroma.…”

Section: Introductionmentioning

confidence: 99%

“…La sindrome di Morton è una metatarsalgia neuralgica causata dall'intrappolamento del nervo digitale comune nel canale metatarsale; il traumatismo continuo determina un processo flogistico perineurale che a sua volta induce proliferazione connettivale endo-perineurale e degenerazione ialina dell'endonevrio [1]. Tale entità anatomo patologica è comunemente conosciuta come neuroma di Morton.…”

Section: Introduzioneunclassified

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Dynamic sonography of the forefoot in Morton’s syndrome: correlation with magnetic resonance and surgery

Perini¹,

Borrello²,

Cipriano³

et al. 2006

Radiol med

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Section: Discussionementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introduzioneunclassified

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Dynamic sonography of the forefoot in Morton’s syndrome: correlation with magnetic resonance and surgery

Perini¹,

Borrello²,

Cipriano³

et al. 2006

Radiol med

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“…Come descritto da Volpe e coll. [9], nella MS rientrano sia quadri iniziali di compressione del nervo digitale plantare al di sotto del legamento trasverso intermetatarsale (TIML), sia quadri più evoluti di vero e proprio rigonfiamento del nervo digitale, che assume l'aspetto del classico neuroma, talora tutt'uno con ingrossamento della borsa intermetatarsale [10]. A questo proposito Weinfield e Myerson propongono il termine di neurite interdigitale ("distal intermetatarsal neuritis", IDN), forse il più adatto a comprendere sia le forme di neuropatia da intrappolamento del nervo digitale sia quelle con evoluzione neuromatosa [11].…”

Section: Introduzioneunclassified

“…Poiché l'arteriola digitale corre a fianco del nervo digitale, ne derivano fattori ischemici ripetitivi, cui viene imputata la progressiva degenerazione della componente nervosa intraneurale. In effetti, sul piano anatomo-patologico, è caratteristica la presenza di ispessimento e sclerosi delle pareti articolari [9]. Accanto a fattori biomeccanici, anche svariati fattori anatomici concorrono alla compressione del nervo.…”

Section: Introduzioneunclassified

La sindrome di Morton

Volpe

2011

LO SCAL

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MORTON'S SYNDROME Morton's syndrome (MS) is a typical metatarsalgia, due to an intermetatarsal neuroma. Patients complain of burning pain in the lateral metatarsal region, extending into the third, fourth or both toes. Patients typically experience pain relief by sitting down, removing the shoe, and massaging the foot. The diagnosis is primarily clinical, producing pain by compression with the fingers in the second or third web-space and moving the neuroma up and down between metatarsal bones according to the Mulder's manouvre. Other sources of forefoot pain can be misdiagnosed as an interdigital neuroma, like metatarsal stress fractures, early rheumatoid arthritis, Freiberg's infraction, biomechanical disorders of the Mp joint. Therefore, diagnosis needs a confirmation with advanced imaging. Ultrasound (US) intermetatarsal exploration of forefoot, reproducing local pain and Mulder's click with dynamic manoeuvres, is today, if performed by a well-experienced examinator, an easy and economical test to confirm clinical suspect, with an accuracy of about 90% for intermetatarsal masses greater than 4 mm. There are differing reports about the accuracy of diagnosis with magnetic resonance imaging (MRI), more indicated as a second level examination fot doubtful cases. As for treatment of MS, alcohol injection under sonographic guidance is today a preferred method for intermetatarsal masses greater than 4 mm. Two or three injections of 1 cc of medical alcohol 30% diluted with 70% of xylocaine 2%, injected directly in the mass, are required. In our experience of 150 published cases, success rate is about 80%, without any hindrance to surgery in case of persistent pain. Surgery is indicated in refractory cases and can be done in a formal operative suite in outpatient surgery. The dorsal intermetatarsal approach is preferred, isolating the neuroma from distal to proximal, after transverse intermetatarsal ligament transection. After careful isolation of the third common digital nerve from the thin plantarly directed branches and, if present, the accessory branch of the lateral plantar nerve, the nerve is resected with a new fifteen blade and passed through the fibers of the transverse adductor muscle (neurectomy/relocation technique) to prevent mechanical irritation in case of a stump neuroma. According to literature, results of surgery have been favorable, with 90% of success, when MS was localized in a third web space, but with a worse outcome in cases with second web space (60%) or multiple web space intervention.

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The Other Nerves

Rigoard

2020

Atlas of Anatomy of the Peripheral Nerves

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Morton's syndrome: surgical strategies according to the digital nerve pathology

Cited by 16 publications

References 5 publications

Dynamic sonography of the forefoot in Morton’s syndrome: correlation with magnetic resonance and surgery

Dynamic sonography of the forefoot in Morton’s syndrome: correlation with magnetic resonance and surgery

La sindrome di Morton

The Other Nerves

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