Owens et al. “Morton's neuroma: Clinical testing and imaging in 76 feet, compared to a control group” [Foot and Ankle Surgery 17 (September (3)) 2011]

Background Previous research indicates low disposal rates of excess postoperative narcotics, leaving them available for diversion or abuse. This study examined the effect of introducing a portable disposal device on excess opiate opioid disposal rates after lower extremity orthopaedic surgery. Methods This was a single site randomized control trial within an outpatient orthopaedic clinic. All patients 18 years or older, undergoing outpatient foot and ankle surgery between December 1, 2017 and August 1, 2018 were eligible. Patients were prospectively enrolled and randomized to receive standard opioid disposal instructions or a drug deactivation device at 2-week postoperative appointments. Participants completed an anonymous survey at 6-week postoperative appointments. Results Of the 75 patients surveyed, 68% (n = 26) of the experimental group and 56% (n = 21) of the control group had unused opioid medication. Of these, 84.6% of patients who were given Deterra Drug Deactivation System deactivation pouches safely disposed of excess medication, compared with 38% of controls (P = .003). When asked if they would use a disposal device for excess medication in the future, 97.4% (n = 37) of the experimental and 83.8% (n = 31) of the control group reported that they would. Conclusions Providing a portable disposal device with postoperative narcotic prescriptions may increase safe disposal rates of excess opioid medication following lower extremity orthopaedic surgery. Levels of Evidence Level I

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Centrocentral Anastomosis with Autologous Nerve Graft Treatment of Foot and Ankle Neuromas

Foot & Ankle International ◽

10.1177/107110079601700205 ◽

1996 ◽

Vol 17 (2) ◽

pp. 85-88 ◽

Cited By ~ 19

Author(s):

Cobi Lidor ◽

Reginald L. Hall ◽

James A. Nunley

Keyword(s):

Peroneal Nerve ◽

Autologous Transplantation ◽

Nerve Graft ◽

Superficial Peroneal Nerve ◽

Foot And Ankle ◽

Morton’S Neuroma ◽

Gun Shot ◽

Morton's Neuroma ◽

Web Space ◽

Objective Improvement

Painful neuromatas in the foot and around the ankle can be difficult to treat. Five patients of clinically and histologically proven neuromas underwent centrocentral union with autologous transplantation. Three patients had previous toe amputations involving multiple operations. One patient had failed multiple operative treatments for Morton's neuroma in his 3rd web space. One patient had a neuroma in his superficial peroneal nerve caused by a gun shot wound. All patients but one showed definitive subjective and objective improvement after centrocentral union with the interposed autologous nerve graft. The patient with “recurrent” Morton's neuroma had the least improvement. This technique can be recommended as an alternative for the prevention of painful stump neuromata.

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Radiographic Analysis of Feet With and Without Morton’s Neuroma

Foot & Ankle International ◽

10.1177/1071100716674998 ◽

2016 ◽

Vol 38 (3) ◽

pp. 310-317 ◽

Cited By ~ 3

Author(s):

Reza Naraghi ◽

Alexandra Bremner ◽

Linda Slack-Smith ◽

Alan Bryant

Keyword(s):

Control Group ◽

Morton’S Neuroma ◽

Level Of Evidence ◽

Intermetatarsal Angle ◽

Control Subjects ◽

Radiographic Measurements ◽

Valgus Angle ◽

Angular Measurements ◽

Morton's Neuroma ◽

And Control

Background: The aim of this research was to investigate the association of various structural measurements of the forefoot with Morton’s neuroma (MN). Methods: Weightbearing anteroposterior and lateral foot radiographs of subjects attending the University of Western Australia (UWA) Podiatry Clinic and the first author’s private practice were included in this study. A single assessor measured the following angles: lateral intermetatarsal angle (LIMA), intermetatarsal angle (IMA), hallux valgus angle (HVA), digital divergence between the second and third digits (DD23), digital divergence between the third and fourth digits (DD34) and relative metatarsal lengths of the first to fifth metatarsals (Met1-5), and the effect of MN size as measured by ultrasonograph on digital divergence. Intratester reliability of all radiographic measurements was assessed on all radiographic measurements. The study included 101 subjects, of whom 69 were diagnosed with MN and 32 were control subjects without MN. The mean (± standard deviation) age of MN subjects was 52 (±15) years and for control subjects, 48 (±12) years. Results: When comparing all feet, there were no significant differences in the LIMA, HVA, IMA, digital divergence angles and the relative metatarsal distances between subjects with MN and control subjects. No relationship between MN size and digital divergence was found in either foot, or in either neuroma location. Conclusion: We were unable to demonstrate any relationship in this study between radiographic metatarsal length and angular measurements in a symptomatic MN group compared to a control group. In addition, we did not find any correlation between the size of MN as measured from ultrasonographic images and radiographic evidence of digital divergence. Level of Evidence: Level III, case control study.

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Corticosteroid Injection for the Treatment of Morton’s Neuroma: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Trial

Foot & Ankle International ◽

10.1177/1071100717709569 ◽

2017 ◽

Vol 38 (9) ◽

pp. 944-951 ◽

Cited By ~ 13

Author(s):

Xavier Lizano-Díez ◽

Alberto Ginés-Cespedosa ◽

Eduard Alentorn-Geli ◽

Daniel Pérez-Prieto ◽

Gemma González-Lucena ◽

...

Keyword(s):

Local Anesthetic ◽

Corticosteroid Injection ◽

Controlled Trial ◽

Case Series ◽

Control Group ◽

Placebo Control ◽

Morton’S Neuroma ◽

Level Of Evidence ◽

Morton's Neuroma ◽

And Function

Background: The effectiveness of corticosteroid injection for the treatment of Morton’s neuroma is unclear. In addition, most of the studies related to it are case-control or retrospective case series. The purpose of this study was to compare the effectiveness between corticosteroid injection associated with local anesthetic and local anesthetic alone (placebo control group) for the treatment of Morton’s neuroma. Methods: Forty-one patients with a diagnosis of Morton’s neuroma were randomized to receive 3 injections of either a corticosteroid plus a local anesthetic or a local anesthetic alone. The patients and the researcher who collected data were blinded to the treatment groups. The visual analog scale for pain and the American Orthopaedic Foot & Ankle Score (metatarsophalangeal/interphalangeal score) were obtained at baseline, after each injection, and at 3 and 6 months after the last injection. Results: There were no significant between-group differences in terms of pain and function improvement at 3 and 6 months after treatment completion in comparison with baseline values. At the end of the study, 17 (48.5%) patients requested surgical excision of the neuroma: 7 (44%) in the experimental group and 10 (53%) in the control group ( P = 1.0). Conclusion: The injection of a corticosteroid plus a local anesthetic was not superior to a local anesthetic alone in terms of pain and function improvement in patients with Morton’s neuroma. Level of Evidence: Level I, randomized controlled trial.

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Randomized Trial of Dilute Povidone-Iodine Soak and Scrub for Orthopedic Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/10711007211025263 ◽

2021 ◽

pp. 107110072110252

Author(s):

Nasima Mehraban ◽

Connor Wakefield ◽

David Rossi ◽

Johnny Lin ◽

Simon Lee ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Povidone Iodine ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Foot And Ankle ◽

Skin Preparation ◽

Randomized Controlled ◽

Positive Bacterial Culture ◽

Ankle Surgery

Background: There is no consensus as to which skin antiseptic solution is most effective at reducing infection following orthopedic foot and ankle surgery. The purpose of this study is to determine if the addition of a dilute povidone-iodine soak and scrub to a standard preparation with alcohol and chlorhexidine decreases positive bacterial culture rates from the hallux nailfold. Methods: In this prospective, randomized controlled trial, 242 subjects undergoing orthopedic foot and ankle surgery were randomized to one of 2 groups. The control group received our standard 2-step skin antiseptic preparation of an alcohol scrub (step 1) followed by chlorhexidine/alcohol paint (step 2). The intervention group received a 3-minute dilute povidone-iodine soak and scrub followed by that same standard 2-step skin preparation. Immediately before skin incision, culture swabs were taken from the hallux nailfold of both groups. Results: Of the 257 subjects enrolled and randomized, 242 (94.2%) completed the study, satisfying the a priori sample size requirement of 242 subjects. There were no crossovers between groups. There were no differences in baseline characteristics between groups ( P > .05 for each). There was no difference in bacterial growth rates between groups (26.8% growth in the intervention group vs 26.9% growth in the control group, P = .991). Conclusion: The hallux nailfold is one of the most difficult to sterilize areas prior to orthopedic foot and ankle surgery. This randomized controlled trail found no benefit to adding a 3-minute dilute povidone-iodine soak and scrub to a standard skin preparation with alcohol and chlorohexidine. Level of Evidence: Level I, randomized controlled trial.

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Postoperative MR Imaging of the Foot and Ankle: Tendon Repair, Ligament Repair, and Morton's Neuroma Resection

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0030-1254524 ◽

2010 ◽

Vol 14 (03) ◽

pp. 357-364 ◽

Cited By ~ 5

Author(s):

Marco Zanetti ◽

Nadja Saupe ◽

Norman Espinosa

Keyword(s):

Mr Imaging ◽

Tendon Repair ◽

Foot And Ankle ◽

Morton’S Neuroma ◽

Ligament Repair ◽

Morton's Neuroma

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Significant prevalence of peripheral artery disease in patients with disturbed wound healing following elective foot and ankle surgery: Results from the ABI-PRIORY (ABI as a PRedictor of Impaired wound healing after ORthopedic surgerY) trial

Vascular Medicine ◽

10.1177/1358863x19883945 ◽

2019 ◽

Vol 25 (2) ◽

pp. 118-123

Author(s):

Arne M Müller ◽

Andreas Toepfer ◽

Norbert Harrasser ◽

Bernhard Haller ◽

Markus Walther ◽

...

Keyword(s):

Wound Healing ◽

Risk Factor ◽

Peripheral Artery Disease ◽

Wound Complications ◽

Control Group ◽

Foot And Ankle ◽

Peripheral Artery ◽

Impaired Wound Healing ◽

Ankle Surgery ◽

Artery Disease

Disturbed wound healing (DWH) following elective foot and ankle surgery is associated with a number of known risk factors. The purpose of this study was to determine if peripheral artery disease (PAD) is a potential risk factor that contributes to an increase in postoperative DWH. In a case–control study, we analyzed all patients undergoing elective foot and ankle surgery between January 1, 2014 and December 31, 2017 at two institutions and identified 51 patients with postoperative DWH. After matching with 51 control patients without DWH, all 102 patients were evaluated for PAD. The prevalence of PAD was significantly higher in the DWH group compared to the control group (41.2% vs 19.6%, p < 0.01). This difference was even more distinctive for patients with any abnormal ankle–brachial index (ABI) (51.0% vs 19.6%, p < 0.001). After adjustment for diabetes, hypertension, hypercholesterolemia, and smoking, any abnormal ABI or a history of PAD remained an independent risk factor for DWH (odds ratio 3.28; 95% CI 1.24–8.71). In this dual-center study, postoperative DWH was associated with significantly higher rates of PAD. These findings suggest that preoperative evaluation for PAD could be a helpful tool to identify patients at high risk for postoperative wound complications undergoing foot and ankle surgery. This trial is registered with drks.de, number DRKS00012580.

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Randomized Trial of Dilute Betadine Soak and Scrub for Orthopaedic Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00139 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0013

Author(s):

Daniel D. Bohl ◽

Nasima Mehraban ◽

David Rossi ◽

Connor Wakefield ◽

Johnny L. Lin ◽

...

Keyword(s):

Controlled Trial ◽

Bacterial Load ◽

Intervention Group ◽

Group Versus ◽

Control Group ◽

Foot And Ankle ◽

Standard Preparation ◽

Randomized Controlled ◽

Positive Bacterial Culture ◽

Ankle Surgery

Category: Lesser Toes; Midfoot/Forefoot; Other Introduction/Purpose: There is no consensus as to which skin antiseptic technique is most effective at reducing bacterial load prior to orthopaedic foot and ankle procedures. The purpose of this study is to determine if the addition of a dilute betadine soak and scrub to a standard preparation with alcohol and chlorhexidine decreases positive bacterial culture rates from the hallux nailfold. Methods: In this prospective, randomized controlled trial, 242 subjects were randomized to one of two groups. The control group received only a standard skin antiseptic preparation with alcohol and chlorhexidine, while the intervention group received a three-minute dilute betadine soak and scrub followed by the standard preparation with alcohol and chlorohexidine (Figure 1). Immediately before skin incision, culture swabs were taken from the hallux nailfold of both groups. Results: Of the 257 subjects enrolled and randomized, 242 (94.2%) completed the study, satisfying the a priori sample size requirement of 242 subjects. There were no crossovers between groups. There were no differences in baseline characteristics between groups (p>0.05 for each). There was no difference in the bacterial growth rate between groups (26.8% growth in the intervention group versus 26.9% growth in the control group, p=0.991). Conclusion: The hallux nailfold is one of the most difficult to sterilize areas prior to orthopaedic foot and ankle surgery. This randomized controlled trail found no benefit to adding a three-minute dilute betadine soak and scrub to a standard skin preparation with alcohol and chlorohexidine.

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Effectiveness of customized insoles in patients with Morton’s neuroma: a randomized, controlled, double-blind clinical trial

Clinical Rehabilitation ◽

10.1177/0269215519873949 ◽

2019 ◽

Vol 33 (12) ◽

pp. 1898-1907 ◽

Cited By ~ 1

Author(s):

Hilda Alcântara Veiga de Oliveira ◽

Jamil Natour ◽

Mariana Vassalli ◽

Andre Rosenfeld ◽

Fabio Jennings ◽

...

Keyword(s):

Control Group ◽

Morton’S Neuroma ◽

Double Blind ◽

Foot Health ◽

Randomized Controlled ◽

Sf 36 ◽

Foot Function ◽

Morton's Neuroma ◽

Arch Support ◽

Foot Health Status Questionnaire

Objective: To assess the effectiveness of customized insole in patients with Morton’s neuroma. Design: Double-blind randomized controlled trial with intent-to-treat analysis. Setting: Outpatients, University Hospital. Subjects: A total of 72 patients with Morton’s neuroma met the inclusion criteria and were randomly allocated to either the study group ( n = 36) or the control group ( n = 36). Interventions: The study group was assigned to use a customized insole with metatarsal and arch support made of ethyl vinyl acetate and the control group received a flat insole of the same material, color, and density. Main measures: The primary outcome measure was walking pain intensity measured by the visual analogue scale. The secondary outcomes were as follows: pain at rest, palpation, and paresthesia (visual analogue scale); functional disability (6-minute walk test, Foot Function Index, and Foot Health Status Questionnaire); quality of life (Health Survey Short Form-36 (SF-36)); and foot pressure (AM Cube FootWalk Pro program). Results: In the comparison between the groups over time, a statistically significant difference, with improvement in favor of the experimental group, was found for pain during walking ( P = 0.048); in the general health domains ( P < 0.001) and physical activity ( P = 0.025) of the Foot Health Status Questionnaire; in the general Foot Function Index score ( P = 0.012); and in the functional capacity domain of the SF-36 questionnaire ( P = 0.046). For the other parameters, no difference was found between groups. Conclusion: The study demonstrated that customized insole with metatarsal and arch support relieved walking pain and improved patient-reported measures of function in patients with Morton’s neuroma.

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