Diagnosis and Treatment of Forefoot Disorders. Section 3. Morton's Intermetatarsal Neuroma

Thomas, James L.; Blitch, Edwin L.; Chaney, D. Martin; Dinucci, Kris A.; Eickmeier, Kimberly; Rubin, Laurence G.; Stapp, Mickey D.; Vanore, John V.

doi:10.1053/j.jfas.2008.12.005

Cited by 43 publications

(20 citation statements)

References 42 publications

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“…Of the potential 109 participants for the study, 89 had completed data elds and were included which represents an 82% completion rate, and an acceptable and comparable sample size for the study. The demographic pro le of the study group is consistent with the reported demographics for age and gender in the literature: IPF does appear to be prevalent across a wide age range and is more common in females (5). This gives the study favourable external validity.…”

Section: Discussionsupporting

confidence: 80%

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Interdigital Perineural Fibroma And A Care Pathway.

Price¹,

Bridgen²

2020

Preprint

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BackgroundInterdigital perineural fibroma (IPF) is a complex condition affecting the plantar nerve of the foot and the care pathway for its management is based upon a consensus of clinical opinions. AimThe aim of the study was to investigate the treatment outcomes within a podiatric surgical practice and produce a validated care pathway over a three-year period.MethodsA retrospective mixed methods design was used to allow combination of quantitative and qualitative data. 89 patients between 1/4/2014 and 1/4/2017 had completed PASCOM-10 audit data. The treatment options were investigated and the MOXFQ domains and PSQ10 outcome scores were subject to analysis with SPSS.FindingsThe mean age of patients in the study was 56 (range 36-86, SD 10.85) and 89% were female, 11% male. 749 patients out of the total caseload had local anaesthetic/steroid injections over the three-year period, of which 49% of the known injections were for Morton’s Neuroma. No outcome data was recorded for injections.89 patients went forward for surgical excision of the IPF. The surgical approach for excision was either dorsal (60.7%) or plantar (39.3%). All plantar incisions (transverse and linear) were analysed as a group for comparison against the dorsal approach. Using an independent t-test, there was no significant difference for dorsal or plantar approach or location of IPF across the three MOxFQ domains and PSQ10.Using a Pearson product moment correlation coefficient there was a moderately strong correlation between the PSQ10 and the MOxFQ domains (n=89, Walking and Standing: r=0.48, p<0.01; Pain: r=0.42, p<0.01; Social Interaction: r=0.40, p<0.01). Where increases in MOxFQ outcome score (amount of improvement) produces higher PSQ10 scores (greater patient satisfaction).ConclusionsMore audit data is required to assess the effectiveness of steroid and / or alcohol injections. Recommendation for practice is based on literature review. The surgical outcomes would suggest that the excision of IPF is an appropriate and effective technique and the surgical approach or location of pathology will not affect the clinical outcomes. A new care pathway for the management of IPF (Morton’s Neuroma) will be employed in practice and

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Section: Discussionsupporting

confidence: 80%

“…The clinical care pathway developed in Fig. 3 is an adapted version from Thomas, et al, 2009, with the addition of relevant research ndings to guide clinicians or patients in treatment choice (5). The yellow boxes show clinical history ndings and the orange box gives the test recommendations.…”

Section: Discussionmentioning

confidence: 99%

Interdigital Perineural Fibroma And A Care Pathway.

Price¹,

Bridgen²

2020

Preprint

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“…Believing that the creation of CCSs would be beneficial to its members, the ACFAS enacted an initiative to create such documents for foot and ankle surgeons. This initiative was originally conceived to report on a variety of topics and to replace previous clinical practice guidelines (4)(5)(6)(7)(8)(9)(10). To move forward with this initiative, a formal consensus method process was undertaken.…”

Section: Creation Of the Panelmentioning

confidence: 99%

American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

Meyr

Mirmiran

Naldo

et al. 2017

The Journal of Foot and Ankle Surgery

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A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.

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“…Meist sind die Beschwerden typisch, sodass eine weitere bildgebende Untersuchung nicht notwendig ist. Erfolgt diese, so kann das Neurom häufig direkt in der MRT-Untersuchung und auch im Ultraschall [158][159][160][161] nachgewiesen werden. Therapie Die Therapie besteht zunächst in konservativen Maßnahmen wie Einlagen mit retrokapitaler Abstützung, Physiotherapie, Verbesserung der Achillessehnenflexibilität, Laufschulung, Gabe nicht steroidaler Antiphlogistika und InfiltrationmitLokalanästhetikumundKortison unter sonografischer Kontrolle [157].…”

Section: Tibialis-anterior-syndromunclassified