The Treatment of Morton’s Neuroma, a Significant Cause of Metatarsalgia for People Who Exercise

Morton’s Neuroma is a common metatarsalgia in athletes created due to the entrapment of the inter-digital nerve inside the transverse inter-metatarsal ligament. The purpose of the present study is to draw the necessary conclusions from the use of a particular surgical treatment to release the digital nerve, accompanied by neurolysis in adults who exercise. On the whole, twenty five patients with twenty-five suffering extremities were treated. Five of them simultaneously had a Hallux Valgus type deformity and that supports the belief of the mechanical induce of this condition. Both ultrasonography and Magnetic Resonance Imaging (MRI) were used for the clinical evaluation of this condition. The pain was estimated via the Visual Analogue Scale (VAS). The patients were re-examined after three (1st postoperative), twelve (2nd postoperative) and twenty-four (3rd postoperative) months. A significant improvement (p 0.0001) was noticed from the correlation between the pain before the surgery and the pain after the surgery via the Visual Analogue Scale (VAS). Most patients (15/25) did not display any discomfort or sensory disorder after surgery. The correct clinical evaluation as well as the correct and effective surgical intervention with the simultaneous repair of all the mechanical deformities of the foot provided better post-surgery progress in patients and increased the percentage of their rehabilitation of their previous activities.

Radiofrequency Thermo-Ablation of Morton’s Neuroma: A Valid Minimally Invasive Treatment Procedure in Patients Resistant to Conservative Treatment

Background: The authors present the personal results of the review of a group of cases treated for Morton’s neuroma with continuous radiofrequency (CRF) thermo-ablation of the plantar intermetatarsal nerve. Methods: This retrospective review consisted of 29 patients treated between January 2008 and December 2011, with a minimum 1 year follow-up. Three patients underwent bilateral treatment and 10 patients underwent concomitant treatment procedures for associated foot disorders: hallux valgus (7), tailor’s bunion (2) and hammertoe (5). The procedure was performed in a day hospital setting under direct fluoroscopic control. Results: The follow-up protocol used a visual analog scale (VAS) for pain (0 = no pain, 10 = worst pain) and a visual analog scale (VAS) for patient satisfaction (0 = no satisfaction, 10 = complete satisfaction). Success was defined by a decrease of 5 points in pain at 1 year after the treatment procedure. From these 29 cases, with a VAS pain score between severe and worst pain ever, treatment with CRF thermo-ablation at one year follow-up yielded these results: 14 cases with no pain (48%), 7 cases with mild pain (24%), 5 cases with moderate pain (17%), 3 cases still with severe pain (10%). The overall benefit was that 88% of the patients had significant pain improvements. From another point of view, 26 cases (89.6%) had a decrease of the VAS score between 5 and 10 points and in only 3 cases (10.3%) severe pain was reported, even though it was slightly diminished after the procedure. Conclusion: Continuous radiofrequency (CRF) thermo-ablation of Morton’s neuroma (Entrapment) was a safe and minimally invasive surgical procedure which gave these patients great satisfactions and a rapid return to normal activity.

Does Greek Foot Predispose to Morton’s Neuroma?

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 self-assessment 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 ﹣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.

Endocsopic Decompression of Intermetatarsal Nerve (EDIN) for the Treatment of Morton’s Entrapment— Multicenter Retrospective Review

Background: The authors present the results of a four surgeon, multicenter study of endoscopic decompression for the treatment of Civinini-Morton’s entrapment of 193 interspaces. Methods: A retrospective review of 193 interspaces, which were decompressed by four different surgeons. Results: The overall success rate was high, with 92% of patients reporting a good or fair outcome. Higher success rates were reported in the 3rd interspace decompression group (95%) compared to the 2nd interspace decompression group (85%). Complications reported were minimal, with only seven cases requiring a revision with traditional neurectomy. No revisions were required in the 3rd interspace decompression group. Five of the revisions were in the 2nd interspace decompression group, with the remaining two revisions in the combined 2nd/3rd interspace decompression group. Conclusions: Endoscopic decompression for the treatment of Civinnini-Morton’s entrapment is a safe and efficacious method of treatment of this nerve entrapment, with very low complication rates and rapid return to normal activity.

Role of imaging methods in diagnosis and treatment of Morton's neuroma

Among the many causes of forefoot pain, Morton's neuroma(MN) is often suspected, particularly in women, due to its high incidence.However, there remain controversies about its relationship with symptomatology and which diagnostic and treatment choices to choose.This article mainly focuses on the role of the various imaging methods and their abilities to support an accurate diagnosis of MN, ruling out other causes of forefoot pain, and as a way of providing targeted imaging-guided therapy for patients with MN.