The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms

Sharp, Robert; Wade, Claire M.; Hennessy, M. S.; Saxby, Terence S.

doi:10.1302/0301-620x.85b7.12633

Cited by 124 publications

(97 citation statements)

References 23 publications

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“…Diagnosis is mainly based on clinical assessment, which is based on the patient's history and the clinical examination [9,17,18]. Ultrasound and MRI are not essential for the diagnosis of Morton's neuroma, because asymptomatic interdigital nerve enlargement is common [8,19,20]. Occurrence of a neuroma remains unreliable unless it is clinically symptomatic [19,20].…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of Morton's neuroma: clinical results after open excision

Kasparek

Schneider

2013

International Orthopaedics (SICOT)

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Purpose Long-term results following surgical treatment of Morton neuroma are rare. The purpose of the present study was to evaluate patients after excision of Morton's neuroma at least ten years following surgery. Methods We performed a retrospective review of the patients' records who underwent excision of an interdigital neuroma with the clinical diagnosis of Morton's neuroma. Eighty-one patients who had undergone surgery on 98 feet were analysed at an average of 15.3 years postoperatively. In total 111 neuromas were excised, because in 13 feet more than one neuroma was identified clinically. Follow-up evaluation included physical examination and a radiographic evaluation. The interdigital neuroma clinical evaluation score and the AOFAS score were assessed. Results An excellent result was reported for 44 feet (44.9 %), a good result for 31 feet (31.6 %) and a fair one for 15 feet (15,3 %). Eight feet had a poor result (8.2 %), in all of them an amputation neuroma was diagnosed. The average neuroma score was 62 points (range 20-80) and the AOFAS score 75 points (range 29-100). Sixty-one feet (62.2 %) had concomitant foot and ankle disorders not related to the primary diagnosis of Morton's neuroma. Numbness was assessed in 72 % (72 feet), a normal sensibility in 26 % (26 feet) and dyaesthesia in 1 % (one foot). The clinical outcome was not influenced by existence of sensory deficits (p=0.646); analysis of location of neuroma showed best results for those in the third webspace. A significantly worse outcome was found in patients operated on multiple neuromas compared to single neuroma (p=0.038). Conclusion Surgical excision of a Morton's neuroma results in good clinical results and high overall patient's satisfaction in the long term. Multiple neuromas have worse outcome than single neuromas. Sensory deficits and concomitant foot and ankles disorders are common, but do not have an influence on patient's satisfaction.

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Section: Introductionmentioning

confidence: 99%

Surgical treatment of Morton's neuroma: clinical results after open excision

Kasparek

Schneider

2013

International Orthopaedics (SICOT)

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“…28 Owens et al also found that a combination of positive clinical tests was a good indicator for the presence of PDN. 22 The two clinical tests used in this current study were also found to be the most sensitive tests in a recent comparison of clinical and radiological diagnosis.…”

Section: Discussionmentioning

confidence: 96%

“…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. 6,28 Indeed, Sharp et al found that clinical tests were more sensitive in the detection of PDN than either ultrasound or MRI.…”

Section: Discussionmentioning

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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“…Diagnosis is usually confirmed by the use of Radiographs, Ultrasound or Magnetic Resonance Imaging (MRI). However, it has been reported that physical examination and the production of Mulder's sign is still the most sensitive and specific method of diagnosing Morton's Neuroma [17]- [20]. Morton's neuroma can be managed conservatively using arch supports, wearing wide toe box shoes, avoidance of high-heels, and padding or taping with the aim of dispersing weight bearing from the site of the neuroma to avoid compression and therefore symptoms.…”

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 role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms

Cited by 124 publications

References 23 publications

Surgical treatment of Morton's neuroma: clinical results after open excision

Surgical treatment of Morton's neuroma: clinical results after open excision

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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