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

Abstract

Purpose: Morton's neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for this condition are sparse, and physiotherapy's usefulness is limited. Client Description: A woman aged 44 years was referred to physiotherapy for left fore foot pain lasting 3 months. The podiatrist diagnosed MN using ultrasonography. Examination found positive squeeze test, painful interphalangeals and metatarsal heads, and painful metatarsophalangeal joint (MPJ) extension. Intervention: Repeated flexion of MPJ digit II relieved the patient's pain. She was treated six times over 3 months to progress treatment, achieve longer lasting pain relief, and recover function to full pain-free status, including running. Measures and Outcome: The patient's pain reduced after treatment from a variable 2-7 out of 10 on the Numeric Pain Rating Scale to 0 out of 10. After two sessions, the patient's Lower Extremity Functional Scale score improved, from 56 out of 80 to 70 out of 80, and by discharge, it was 73 out of 80. At 6-month follow-up, the patient was still running pain-free. Implications: This article describes the rapid and lasting improvement in chronic forefoot pain associated with MN after mechanical diagnosis and therapy assessment and treatment. Finding new, effective, conservative interventions is important for this condition because so few evidence-supported treatments exist. The findings from this case report demonstrate the benefit derived from exercise-based treatment and may indicate a role for physiotherapy in managing MN.

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

“…Contrary to the clinical practice guidelines [5], which advocate therapeutic injections and surgery as the first-line treatment approach for management of this condition, this series applied clinician-assisted and self-treatment options for patients with medically diagnosed MN following clinical and imaging testing. Combined with a recently published report [14], these patients further the potential long-term benefits following examination and treatment utilizing the MDT system for MN.…”

“…Given the difficult differential diagnosis of patients with metatarsalgia, it is likely that a number of patients responsive to manual therapy within that study would have met diagnostic criteria of symptomatic MN according to current diagnostic standard [2,5]. The current series, and a prior report [14], demonstrates use of manual therapy and repeated end range movements as an effective treatment option that provides long-term relief of symptoms for those with MN.…”

“…To date, there are limited cases in the literature which are suggestive of the utility of physical therapy in the presence of medically diagnosed Morton's neuroma. The overall prevalence rates when classifying this condition utilizing the MDT classification system is unknown [14,22].…”

“…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]. The author reported using repeated and loaded end range metatarsophalangeal joint (MPJ) flexion to create a rapid improvement in the patient's pain and functional level, sustained at 6 months.…”