What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma?

Mahadevan, Devendra; Salmasi, Mohammad Yousuf; Whybra, Nicola; Nanda, Anika; Gaba, Suchi; Mangwani, Jitendra

doi:10.1016/j.fas.2015.03.007

Cited by 24 publications

(23 citation statements)

References 14 publications

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“…The results of this study suggest that the size of the neuroma is the sole predictor of failure of corticosteroid injections for the treatment of Morton neuroma. This finding is consistent with the results of previous publications . Intermetatarsal distance, another ultrasonographic parameter, did not predict the clinical prognosis of Morton neuroma.…”

Section: Discussionsupporting

confidence: 92%

“…In a previous radiographic analysis of the feet of individuals with Morton neuroma, there were no substantial relationships between radiologic parameters including intermetatarsal distance and development of neuroma . Morphometric analyses of Morton neuroma have been performed mainly through ultrasonography, and many authors have concluded that larger neuromas tend more often to be symptomatic and to require surgical treatment . According to the available evidence, neuroma size is the single most important factor for predicting symptom development and prognosis.…”

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confidence: 99%

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Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study

Park

Kim

Choi

et al. 2018

J of Ultrasound Medicine

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Objectives This study aims to evaluate the clinical importance of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space in examinations of Morton neuroma using ultrasonography. Methods Clinical prognosis was observed prospectively after corticosteroid injections in 136 patients with Morton neuroma, and the results were compared with ultrasonographic parameters of intermetatarsal distance, size of neuroma, and proportion of neuroma in the intermetatarsal space. Results Twenty‐one patients (15%) did not respond to corticosteroid injections and underwent surgical treatment for Morton neuroma. Logistic regression analysis and receiver operating characteristic curve analysis showed that the size of the neuroma was the sole predictor of failure of corticosteroid injections (P = .002). No other factors were significant for the prediction of clinical prognosis (P > .05). Conclusions The size of the neuroma on ultrasonography is the sole predictor of corticosteroid injection failure, while intermetatarsal distance and proportion of neuroma in the intermetatarsal space are not significant when predicting clinical prognosis of Morton neuroma.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study

Park

Kim

Choi

et al. 2018

J of Ultrasound Medicine

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“…The literature does not suggest a set agreement scale or rate to define consensus [ 8 ]. However there is general concurrence that the researchers should identify and define an agreement scale/rate for consensus to their participants and this is what is adopted for the Delphi study [ 4 , 11 ]. In round 4, participants were asked to rank the strength of recommendation they would give (where 1 was the lowest rank or lowest strength of recommendation).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, authors have investigated specific clinical tests to determine their sensitivity, specificity, their positive predictive value, and their negative predictive value in clinically diagnosing forefoot neuroma. Mahadevan et al [ 11 ] compared 7 clinical tests to detect forefoot neuroma compared to ultrasound. The overall accuracy rate of these clinical tests were as follows: thumb index finger squeeze (96%), Mulder’s click (61%), foot squeeze (41%), plantar percussion (37%), dorsal percussion (33%), abnormal light touch (26%) and abnormal pin prick (26%).…”

Section: Introductionmentioning

confidence: 99%

The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study

Dando

Cherry

Jones

et al. 2017

Journal of Foot and Ankle Research

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BackgroundThere is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagnosis of forefoot neuroma.MethodsA four-round Delphi consensus study was completed with 16 expert health professionals from either a clinical or clinical academic background, following completion of a structured literature review. Clinical experience ranged from 5 to 34 years (mean: 19.5 years). Consensus was sought on the optimal methods to achieve the clinical diagnosis of forefoot neuroma. Round 1 sought individual input with an open ended question. This developed a list of recommendations. Round 2 and 3 asked the participants to accept or reject each of the recommendations in the list in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” Votes that were equal to or greater than 60% were accepted into the next round; participant’s votes equal to or less then 20% were excluded. The remaining participant’s votes between 20 to 60% were accepted and placed into the following round for voting. Round 4 asked the participants to rank the list of recommendations according to the strength of recommendation they would give in relation to the question: “What is the best way to clinically diagnose neuroma in the forefoot?” The recruitment and Delphi rounds were conducted through email.ResultsIn round 1, the 16 participants identified 68 recommendations for the clinical diagnosis of forefoot neuroma. In round 2, 27 recommendations were accepted, 11 recommendations were rejected and 30 recommendations were assigned to be re-voted on. In round 3, 36 recommendations were accepted, 22 recommendations were rejected and 11 recommendations were assigned to be re-voted on. In round 4, 21 recommendations were selected by the participants to form the expert derived clinical assessment protocol for the clinical diagnosis of forefoot neuroma. From these 21 recommendations, a set of themes were established: location of pain, non weight bearing sensation, weight bearing sensation, observations, tests and imaging.ConclusionFollowing the identification of 21 method recommendations, a core set of clinical diagnostic methods have been prepared as a clinical assessment protocol for the diagnosis of forefoot neuroma. Based on expert opinion, the core set will assist clinicians in forming a clearer diagnosis of forefoot neuroma.Electronic supplementary materialThe online version of this article (10.1186/s13047-017-0241-2) contains supplementary material, which is available to authorized users.

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“…Sonography has also been used to predict the prognosis of Morton neuromas, in addition to its use in diagnosis and treatment. In previous studies, many authors indicated that the size of the neuroma is strongly associated with symptom development and prognosis . In addition, a recent study indicated that the size of the neuroma was a risk factor for failure of corticosteroid injection and that the cutoff value was 6.3 mm .…”

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confidence: 99%

Intra‐ and Interobserver Reliability of Size Measurement of Morton Neuromas on Sonography

Park

Choi

et al. 2019

J of Ultrasound Medicine

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Objectives-Sonography is often used for analysis of Morton neuromas, but the measurement reliability is unknown. The aim of this study was to determine the intra-and interobserver reliability and precision of sonographic measurement of Morton neuromas.Methods-Three observers with different levels of sonography experience (observer A, expert; observer B, intermediate; observer C, beginner) performed repeated measurements of the size of Morton's neuroma in 20 patients. Intraclass correlation coefficient and limit of agreement were used to evaluate reliability and measurement precision.Results-The intraclass correlation coefficient for intraobserver reliability was 0.80, 0.71, and 0.43 (limit of agreement, 20%, 18%, and 47%) in observers A, B, and C, respectively. The intraclass correlation coefficient for interobserver reliability was 0.72, 0.38, and 0.38 (limit of agreement, 25%, 36%, and 35%) between observers A/B, A/C, and B/C, respectively. Conclusions-The intra-and interobserver reliability values for sonographic measurement of Morton neuroma size were dependent on observer experience. Experienced observers had higher reliability, while observers who were less familiar with sonography showed moderate to low reliability.

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What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma?

Cited by 24 publications

References 14 publications

Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study

Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study

The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study

Intra‐ and Interobserver Reliability of Size Measurement of Morton Neuromas on Sonography

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