Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

Abstract

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.

The effectiveness of non‐surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta‐analysis

“…Confusion surrounds the name MN, with many alternative descriptions for the condition (e.g. intermetatarsal neuroma [5, 19], intermetatarsal neuritis [5], plantar interdigital neuroma [1, 7, 20], interdigital neuroma [3, 4, 10, 21], interdigital neuralgia [22], interdigital neuritis [23] and plantar digital neuralgia [2]) and no histological evidence of a true neuroma with axonal degeneration and collagen proliferation [24].…”

Mechanical Diagnosis and Therapy and Morton’s Neuroma: A Case Report

“…1,2 It is the most common neuropathy after carpal tunnel syndrome. 3 A recent sys tematic review concluded that support for non-operative and operative management consisted of low-quality research and sample sizes or of poorly controlled case series. 1 The current podiatrist clinical practice guidelines do not include manual therapy or physiotherapy as a treat ment option before surgical intervention to manage MN.…”

Mechanical diagnosis and therapy and Morton’s neuroma: a case-series

“…Chiropractic and podiatric literature have reported success within this population in application of passive manual interventions, such as manipulation, to provide short-term relief of patient's symptomatic complaints [4,13]. A PT reported a single-case following a similar approach to describe short-term reductions in painpressure threshold testing [22].…”

“…A Cochrane review concluded that results of conservative care are so poor that initial treatment should be surgery [1]. Although surgery is generally accepted as a gold-standard first line of treatment, podiatrists contend that there is no convincing evidence that surgery results in better patient outcomes than conservative care [4]. Surgery has resulted in variable success (62-83%) and is dependent upon accurate diagnosis as there is a potential for excision of asymptomatic interdigital nerves [1,2].…”

“…Providers of manual therapy (MT) who are not physical therapists, have reported literature supportive of MT intervention for MN [4,13]. A recent case report has demonstrated efficacy of a PT intervention with the use of repeated end range movements in a patient with medically-diagnosed MN [14].…”