The Causative Mechanism in Morton's Metatarsalgia

Mulder, J.

doi:10.1302/0301-620x.33b1.94

Cited by 203 publications

(67 citation statements)

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“…Using a plantar and a dorsal approach, the patients were scanned in the transverse and longitudinal planes with regard to the metatarsal shafts. Thereafter, the longitudinal and transverse diameters of the neuroma were measured [14,29].…”

Section: Methodsmentioning

confidence: 99%

Treatment of intermetatarsal Morton?s neuroma with alcohol injection under US guide: 10-month follow-up

et al. 2004

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Morton's neuroma (MN) is a frequent cause of metatarsalgia. The aim of our study was to evaluate the efficacy of neuroma alcoholsclerosing therapy (NAST) under US guide in MN after a 10-month follow-up. Forty intermetatarsal neuromas underwent alcohol-sclerosing therapy after sonographic evaluation of their dimensions and echotexture. After subcutaneous anesthesia, a sclerosing solution composed of anesthetic (carbocaine-adrenaline 70%) and ethylic alcohol (30%) was injected inside the mass under US guidance. The procedure was repeated at intervals of 15 days until the resolution of the symptoms. A total or partial symptomatic relief was obtained in 36 cases (90%). No procedure-related complications were observed. Transitory plantar pain, due to the flogistic reaction induced by the sclerosing solution, occurred in 6 cases (15%). The 10-month follow-up revealed a 20-30% mass volume reduction and an adiposus-like change in echotexture. In the 4 cases (10%) of therapeutic failure, the preliminary sonography demonstrated a hypoechoic echotexture with a strong US beam attenuation corresponding to a highly fibrous neuroma after surgical resection. The NAST is a feasible and cost-efficient procedure with high rates of therapeutic success.

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Section: Methodsmentioning

confidence: 99%

Treatment of intermetatarsal Morton?s neuroma with alcohol injection under US guide: 10-month follow-up

et al. 2004

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“…20,24 Mulder's click test has long been established as a reliable test for the presence of PDN. 20,21,24,27 Most cases of PDN can be diagnosed clinically 5,8,15 with those being considered for surgical or invasive intervention having the diagnosis confirmed by ultrasound or magnetic resonance imaging (MRI) if necessary. 9 This said, clinical tests may be just as useful especially in detecting smaller lesions which can be missed by ultrasound and MRI, yet which cause the sufferer just as much discomfort.…”

Section: Discussionmentioning

confidence: 99%

“…Subjectively, this may reproduce the patient's symptoms but a test is only considered positive if the objective sign of a palpable click is elicited. 21 It is important to note that what Morton referred to as a click is palpable rather than audible. There is no sound emitted from the area but rather the click is felt inside the foot.…”

Section: Interventionmentioning

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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“…On examination a positive Mulder's sign is elicited, which is the production of a palpable, painful clicking sound when the interspace is palpated whilst the metatarsal heads are compressed laterally, causing the neuroma to be subluxed beneath the transverse metatarsal ligament [16] (Figure 1). Diagnosis is usually confirmed by the use of Radiographs, Ultrasound or Magnetic Resonance Imaging (MRI).…”

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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The Causative Mechanism in Morton's Metatarsalgia

Abstract: 1. A clinical test of diagnostic significance in Morton's metatarsalgia is described. 2. Findings at operation in twelve cases are recorded. 3. The causation of the digital neuroma is discussed.

Cited by 203 publications

References 0 publications

Treatment of intermetatarsal Morton?s neuroma with alcohol injection under US guide: 10-month follow-up

Treatment of intermetatarsal Morton?s neuroma with alcohol injection under US guide: 10-month follow-up

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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