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.

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.

Morton’s Neuroma;Surgical Exploration Is an Option in Symptomatic Patients with Normal Investigation

Morton neuroma is well described problem to metatarsophalangeal Joint (MTPJ) Etiology of Morton’s Neuroma which has wide range of problems from trauma, and nerve hypertrophy etc. Clinical evaluation is very important for diagnosis and sometimes investigations like ultrasound or MRI scan are helpful for conformation of diagnosis. Management varies from orthotics, shoe modification, injections or surgical excision. We are reporting a case which showed importance of surgical exploration when investigation is normal and difficulty in making diagnosis clinically.

Clinical associations of corneal neuromas with ocular surface diseases

Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.

Development and Validation of a Deep Learning Predictive Model Combining Clinical and Radiomic Features for Short-Term Postoperative Facial Nerve Function in Acoustic Neuroma Patients

Objective This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging(MRI)for short-term postoperative facial nerve function in patients with acoustic neuroma.Methods A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included.Clinical data and raw features from four MRI sequences(T1-weighted,T2-weighted,T1-weighted contrast enhancement,and T2-weighted-Flair images)were analyzed.Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features.Nomogram,machine learning,and convolutional neural network(CNN)models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery.Receiver operating characteristic(ROC)curve and decision curve analysis(DCA)were used to evaluate model performance.A total of 1050 radiomic parameters were extracted,from which 13 radiomic and 3 clinical features were selected.Results The CNN model performed best among all prediction models in the test set with an area under the curve(AUC)of 0.89(95%CI,0.84–0.91).Conclusion CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma.As such,CNN modeling may serve as a potential decision-making tool for neurosurgery.

A decellularized nerve matrix scaffold inhibits neuroma formation in the stumps of transected peripheral nerve after peripheral nerve injury

Traumatic painful neuroma is an intractable clinical disease characterized by improper extracellular matrix(ECM)deposition around the injury site.Studies have shown that the microstructure of natural nerves provides a suitable microenvironment for the nerve end to avoid abnormal hyperplasia and neuroma formation.In this study,we used a decellularized nerve matrix scaffold(DNM-S)to prevent against the formation of painful neuroma after sciatic nerve transection in rats.Our results showed that the DNM-S effectively reduced abnormal deposition of ECM,guided the regeneration and orderly arrangement of axon,and decreased the density of regenerated axons.The epineurium-perilemma barrier prevented the invasion of vascular muscular scar tissue,greatly reduced the invasion ofα-smooth muscle actin-positive myofibroblasts into nerve stumps,effectively inhibited scar formation,which guided nerve stumps to gradually transform into a benign tissue and reduced pain and autotomy behaviors in animals.These findings suggest that DNM-S-optimized neuroma microenvironment by ECM remodeling may be a promising strategy to prevent painful traumatic neuromas.

Regenerative peripheral nerve interface prevents neuroma formation after peripheral nerve transection

Neuroma formation after peripheral nerve transection often leads to severe neuropathic pain.Regenerative peripheral nerve interface has been shown to reduce painful neuroma in the clinic.However,no reports have investigated the underlying mechanisms,and no comparative animal studies on regenerative peripheral nerve interface and other means of neuroma prevention have been conducted to date.In this study,we established a rat model of left sciatic nerve transfection,and subsequently interfered with the model using the regenerative peripheral nerve interface or proximal nerve stump implantation inside a fully innervated muscle.Results showed that,compared with rats subjected to nerve stump implantation inside the muscle,rats subjected to regenerative peripheral nerve interface intervention showed greater inhibition of the proliferation of collagenous fibers and irregular regenerated axons,lower expressions of the fibrosis markerα-smooth muscle actin and the inflammatory marker sigma-1 receptor in the proximal nerve stump,lower autophagy behaviors,lower expressions of c-fos and substance P,higher expression of glial cell line-derived neurotrophic factor in the ipsilateral dorsal root ganglia.These findings suggested that regenerative peripheral nerve interface inhibits peripheral nerve injury-induced neuroma formation and neuropathic pain possibly via the upregulation of the expression of glial cell line-derived neurotrophic factor in the dorsal root ganglia and reducing neuroinflammation in the nerve stump.

基于分块Morton压缩和混合生成准则的地形简化方法

针对利用Morton编码规则压缩数字高程模型(DEM)数据存在的只适用于较平缓地形的问题,提出了基于地表粗糙度的Morton分块压缩方法.在地形分块时采用二级划分方法,只对地表粗糙度比较小的地形块编码压缩,减少数据读取及编码数量,提高压缩速率;在建模部分,首先对基于地形局部熵的生成准则进行改进,形成一种视相关局部熵生成准则,利用此准则对近处地形进行简化,然后将此准则与Phong光照模型相结合形成一种混合生成准则,用Phong光照模型对远处地形简化.实验结果表明,采用文中方法可以在有效地减少绘制三角形的同时保留地形局部细节,提高了地形可视化效果.

基于Morton码的土地空间网格数据组织与检索

为了更好地解决农业应用中空间信息的共享和利用问题,该文提出基于Morton码的空间网格数据的组织与编码方法。将宁夏自治区的土地利用现状图划分为3个层次的空间网格,通过3层编码使得最终的网格精度达到1m2,并基于二维游程码对空间数据进行无损压缩。同时,在总结了空间网格在各应用领域的一般性检索要求的基础上,通过关系型数据库设计了索引结构。最后利用VS2010.net4.0与SQL Server2008进行验证。试验表明,基于Morton码的空间网格数据的组织与检索方法节省了存储空间,能够使网格数据压缩到总网格数目的1/10。同时,提高了对空间数据的检索速度,克服了每个图斑的二维游程数不固定的技术困难,查询的速度可达到每秒检索数万条记录。该文对于农业空间信息资源的组织与管理提供了一种较为有效的方法。

基于Morton码的图像分裂合并算法研究

分裂合并算法是一种基于区域的串行图像分割算法。在图像的分裂阶段,从图像区域的表示出发,引入Morton码,降低了算法的空间复杂度。同时在图像的相邻区域的合并阶段,提出了一种新的合并原则,增加了满足合并条件的相邻区域的匹配率,减少算法的迭代次数,提高了算法的执行效率。最后给出并分析了相关的实验数据,证明了算法的有效性。

跖骨近端Z形截骨短缩手术治疗成人症状性Morton趾

背景：临床上症状性Morton趾较为少见,目前国内外鲜有关于其手术治疗方面的报道。目的：采用跖骨近端Z形截骨短缩手术治疗症状性Morton趾,并评价其初期疗效。方法：2014年1月至2014年12月,对6例（10足）Morton趾患者实施相对较长跖骨的近端Z形截骨短缩手术,评价患足手术前后影像学改变及美国足踝外科协会（AOFAS）评分差异。结果：患者均获得9-21个月,平均（15.0±4.6）个月随访。截骨部位均获得骨性愈合,愈合时间10-14周,平均（11.6±2.7）周。术前第1、2跖骨相对长度差为11.5-15.5 mm,平均（14.3±2.7）mm,术后为2.0-6.0 mm,平均（3.9±1.2）mm,有统计学差异（P〈0.05）。第2跖骨短缩8.0-13.5 mm,平均（10.1±3.3）mm,约占第2跖骨长度的16.4%。而AOFAS评分由术前的48-64分,平均（57.3±6.0）分提高到术后的74-87分,平均（81.0±5.6）分,有统计学差异（P〈0.05）。结论：对于症状性Morton趾,对相对较长的跖骨采用跖骨近端Z形截骨短缩手术可以有效纠正畸形、恢复正常的跖骨头相对长度,患足疼痛及外观改善明显,但远期疗效仍需进一步观察。

激光显微发射光谱Morton法计算公式和计算方法

提出一种激光显微发射光谱Morton分析法的计算公式和计算方法。既量化Morton法的原理,又不再需要实测激光在样品上形成孔穴体积和样品密度,也不需要绘制分析曲线,仅通过简单计算即可获得样品中元素含量,从而可以减少取样重量误差对分析结果的影响和提高工作效率。

基于十进制Morton码的线性四叉树动态编码方法研究

本文提出一种在遍历栅格矩阵的过程中直接生成四叉树的动态编码方法。该方法用栈代替常规线性表,在提取栅格后,直接检测其属性值、生成Morton码,并同步地对已检测过的栅格进行合并,以动态地建立线性四叉树。本文叙述了这种动态编码方法的思维,并给出了实现该方法的算法,最后根据测试结果比较了动态编码与静态编码的运行效率和内存占用量。

足底跖腱膜炎合并Morton神经瘤1例

足底跖腱膜炎多与跖腱膜损伤、过劳有关,少数患者无明确原因。Morton神经瘤又称为跖间神经瘤,是由趾总神经受到刺激或压迫等原因,以及神经本身引起的一系列病理变化而引发疼痛等症状的综合征[1]。两者均为足底前跖痛的常见原因,由于两者的常见发病部位、临床表现以及超声表现不同,典型病例容易诊断及鉴别。

Morton氏病的治疗体会

Ｍｏｒｔｏｎ氏病的治疗体会吴锡文，李大成，张刚，黄启祥（济南市中心医院麻醉科，济南２５００１３）Ｍｏｒｔｏｎ氏病又称跖神经痛，系趾间跖神经分支长期受压，引起退行性改变或其周围组织增生而引发足底痛。我院近年来诊治１６例病人，１５例采用局部神经阻滞加小针...

The outcome after using two different approaches for excision of Morton＇s neuroma

Background The choice for the surgical approach of interdigital neuroma in the foot is controversial.Plantar approach can leave a painful scar on weight bearing area; hence, some prefer dorsal approach.The aim of the current study was to measure the outcome of interdigital （Morton＇s） neurectomy performed by a single surgeon using dorsal and plantar approaches.Methods A retrospective review of the patient records of one orthopaedic foot and ankle surgeon identified thirty-six patients （42 feet） who had been treated operatively for a primary, persistently painful interdigital neuroma.The mean follow-up was 18 months.Pain, weight bearing, wound problems and rehabilitation period were studied.Results The duration to full weight bearing, return to work, driving and recreational activities were at least one week shorter in the dorsal group.The overall satisfaction for surgery was rated as excellent or good in 85% of the thirty six patients.Scar problems were more troublesome and common in the plantar group.There was residual numbness noticed in twenty feet, the pattern of numbness was quite variable and it was bothersome in only seven feet.There was one recurrence in the plantar group.Conclusions Resection of a symptomatic interdigital neuroma through a dorsal or a plantar approach can result in a good outcome.Dorsal approach, however, is associated with better rehabilitation and less scar problems.

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.

Morton神经瘤的研究进展

磁共振成象和超声波有助于对Morton神经瘤作出定性、定位诊断。