Diagnosis and Treatment of Forefoot Disorders. Section 5. Trauma

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.2008.12.007

Cited by 12 publications

(5 citation statements)

References 46 publications

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“…However, it should be noted that isolated MN 2/3 occurs less frequent and therefore the sample size of this subgroup is relatively small [2]. Our findings of an increased IPA and IMA support the theory that the MN exerts pressure on the distal metatarsals and the proximal phalanges in the corresponding interspaces [21–23]. Surprisingly, we did not find a correlation of the size of the MN in the MRI for the increased IPA 3/4.…”

Section: Discussionsupporting

confidence: 67%

“…A simple radiographic measurement of digital divergence might be highly helpful to facilitate the diagnosis of a MN that sometimes can be difficult to distinguish from other forefoot disorders, especially when an MRI or an experienced ultrasound examiner is not available. An increased digital divergence in the intermetatarsal space affected by MN, that can be seen radiographically, was described before [21, 22]. Previous studies investigated a digital divergence radiographically caused by the MN, but failed to demonstrate a significant relationship [23, 24].…”

Section: Introductionmentioning

confidence: 70%

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The interphalangeal angle as a novel radiological measurement tool for Morton's neuroma – a matched case‐control study

Zaleski

Tondelli

Hodel

et al. 2021

Journal of Foot and Ankle Research

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Background The aim of this retrospective study was to examine if a correlation between Morton’s Neuroma (MN) and an increased interphalangeal angle (IPA) or intermetatarsal angle (IMA) can be found in preoperative weightbearing dorsal-plantar X-rays of the foot. Methods Forty-five patients with forty-nine MN in the interspaces 2/3 or 3/4 and 49 controls were recruited for this study. Every MN was matched with an asymptomatic control without history of metatarsalgia. The diagnosis was made by clinical examination, magnetic resonance imaging (MRI) and positive histopathology after operative resection. IMA 1/5, 2/3, 2/4, 2/5, 3/4 and IPA 2/3, 3/4 were measured for both groups. Results The IPA 3/4 was significantly enlarged by 2.8 degrees (p < 0.001) with Area under the curve (AUC) 0.75 (p < 0.001), sensitivity of 73% and specificity of 67% in feet with MN compared to controls. The IMA 3/4 was significantly enlarged by 1 degree (p < 0.048) with AUC 0.64 (p < 0.031), sensitivity of 71% and specificity of 43% in feet with MN compared to controls. No difference between IMA 2/4, 2/5, 1/5 or correlation between IPA or IMA and the size of the MN in the MRI was found. Conclusion The results confirm the clinical observation of an increased IPA in patients with MN. An increased IPA should therefore be considered in the diagnosis of MN.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 70%

The interphalangeal angle as a novel radiological measurement tool for Morton's neuroma – a matched case‐control study

Zaleski

Tondelli

Hodel

et al. 2021

Journal of Foot and Ankle Research

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“…Bennett et al 1995 noted that 85% of 115 patients found that they had improvement from non-surgical treatment and just 21% required surgical excision [4]. However, in a systematic review of non-surgical interventions Matthews et al 2019 found only limited evidence for non-surgical treatment though it was still recommended that non-surgical treatment should always be attempted prior to surgery [11,12,13,14].…”

Section: Resultsmentioning

confidence: 99%

The Patient Focused Outcomes of Neuroma Excision at a Mean Follow-up of 8 Years and 10 Months

Coutts

Kilmartin

2020

Preprint

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Background - While the majority of patients do well following neuroma excision, good outcomes are far from universal. Hence we always provide a course of non-surgical treatment prior to surgery – footwear advice, orthotics, patient education and up to 3 corticosteroid injections. Furthermore, we wanted to understand and quantify the risks and complication to allow us to be able to provide this information to patients during informed consent.Methods - Between 2000 and 2012 neuroma excision from the 2nd intermetatarsal or 3rd intermetatarsal space was carried out consecutively on 42 cases (36 patients), for the treatment of IM neuroma pain. Three patients from the cohort died prior to follow-up and 6 cases failed to attend for review. The outcomes of surgery were measured in a service review using a visual analogue pain scale, the Manchester Oxford Foot Questionnaire, clinical examination of the foot and consultation with the patient where any adverse issues were recorded. The mean follow-up period was 8-years and 10-months (range 61-194 months). At the time of surgery, the mean age of the patients was 54-years of age (range 25-74 years) and at follow-up the mean age was 63-years of age (range 31-85 years). Results - Twenty four cases (73%) reported they were completely satisfied with the results of their surgery, 8 cases (24%) were satisfied with reservations and 1 case (3%) reported they were dissatisfied. All cases agreed they would be happy to undergo surgery under similar circumstance again if required, i.e. under local anaesthesia on a day case basis. 2 cases (6%) reported recurrence of symptoms and required revision surgery which was performed in one case at 9-years and in the other at 11-years. After further excision of nerve tissue, their symptoms resolved.Conclusion - Neuroma excision is a reasonably safe and effective treatment for neuroma pain when non-surgical treatments fail to resolve symptoms. Our approach requires meticulous clinical examination and history taking, up to three cortisone injections and then ultrasound examination before the patient is listed for surgery. In this way we hope to minimise the risk of incorrect diagnosis and continued pain post excision due to the presence of undiagnosed capsulitis.

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Section: Resultsmentioning

confidence: 99%

A service review of the patient focused outcomes of neuroma excision at a mean follow-up of 8 years and 10 months

Coutts¹,

Kilmartin²

2020

Preprint

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Background - While the majority of patients do well following neuroma excision, good outcomes are far from universal. Hence we always provide a course of non-surgical treatment prior to surgery – footwear advice, orthotics, patient education and up to 3 corticosteroid injections. Furthermore, we wanted to understand and quantify the risks and complication to allow us to be able to provide this information to patients during informed consent.Methods - Between 2000 and 2012 neuroma excision from the 2nd intermetatarsal or 3rd intermetatarsal space was carried out consecutively on 42 cases (36 patients), for the treatment of IM neuroma pain. Three patients from the cohort died prior to follow-up and 6 cases failed to attend for review. The outcomes of surgery were measured in a service review using a visual analogue pain scale, the Manchester Oxford Foot Questionnaire, clinical examination of the foot and consultation with the patient where any adverse issues were recorded. The mean follow-up period was 8-years and 10-months (range 61-194 months). At the time of surgery, the mean age of the patients was 54-years of age (range 25-74 years) and at follow-up the mean age was 63-years of age (range 31-85 years).Results - Twenty four cases (73%) reported they were completely satisfied with the results of their surgery, 8 cases (24%) were satisfied with reservations and 1 case (3%) reported they were dissatisfied. All cases agreed they would be happy to undergo surgery under similar circumstance again if required, i.e. under local anaesthesia on a day case basis. 2 cases (6%) reported recurrence of symptoms and required revision surgery which was performed in one case at 9-years and in the other at 11-years. After further excision of nerve tissue, their symptoms resolved.Conclusion - Neuroma excision is a reasonably safe and effective treatment for neuroma pain when non-surgical treatments fail to resolve symptoms. Our approach requires meticulous clinical examination and history taking, up to three cortisone injections and then ultrasound examination before the patient is listed for surgery. In this way we hope to minimise the risk of incorrect diagnosis and continued pain post excision due to the presence of undiagnosed capsulitis.

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Diagnosis and Treatment of Forefoot Disorders. Section 5. Trauma

Cited by 12 publications

References 46 publications

The interphalangeal angle as a novel radiological measurement tool for Morton's neuroma – a matched case‐control study

The interphalangeal angle as a novel radiological measurement tool for Morton's neuroma – a matched case‐control study

The Patient Focused Outcomes of Neuroma Excision at a Mean Follow-up of 8 Years and 10 Months

A service review of the patient focused outcomes of neuroma excision at a mean follow-up of 8 years and 10 months

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