scholarly journals Five Centimeters Morton's Neuroma in a 46-Year-Old Woman Affected by Macrodactily

Joints ◽  
2020 ◽  
Author(s):  
Francesco Di Caprio ◽  
Renato Meringolo ◽  
Maria Adiletta Navarra ◽  
Massimiliano Mosca ◽  
Lorenzo Ponziani
Keyword(s):  
Surgical Approach ◽  
Raynaud’S Phenomenon ◽  
Raynaud's Phenomenon ◽  
Morton’S Neuroma ◽  
Plantar Surface ◽  
Lateral Plantar Nerve ◽  
The Third ◽  
Deep Branch ◽  
Morton's Neuroma ◽  
Intrinsic Muscles

AbstractThe present article described the case of a voluminous Morton's neuroma of the third intermetatarsal space in a patient affected by macrodactily. The case was unique because of its dimensions, the uncommon surgical approach which was needed for removal, the association with macrodactily of the fourth toe with Raynaud's phenomenon, and the postoperative defect in the intrinsic muscles. The patient was operated in February 2016 by transverse plantar approach. Twelve months after surgery, the patient complained for hypoesthesia on third and fourth toes with inability to actively spread the toes and enlargement in the second interdigital space. The dimensions of the lesions may be explained with the presence of macrodactily in the fourth toe with occasional Raynaud's phenomenon, which may have caused an abnormal arrangement of the nerve branches for the fourth interspace with related microtrauma. A plantar approach was highly recommended as the size of the lesion forced it to the plantar surface of the foot. The inability to actively spread the toes and the enlargement of the second interdigital space are likely to be related to a deficiency of the interosseous muscles, innervated by the deep branch of the lateral plantar nerve, which had probably been sacrificed because of the size of the lesion and the subversion of the surrounding anatomical relationships.

Etiology of symptomatic recurrent interdigital neuromas

1993 ◽  
Vol 83 (5) ◽  
pp. 255-258 ◽  
Author(s):  
G Young ◽  
J Lindsey
Keyword(s):  
Surgical Resection ◽  
Common Disease ◽  
Disease Entity ◽  
Morton’S Neuroma ◽  
Plantar Surface ◽  
Amputation Neuroma ◽  
Morton's Neuroma

Morton's neuroma is a common disease entity of the foot that is often treated with surgical resection. A complication of neuroma resection is recurrence of symptoms as a result of the formation of an amputation neuroma. The authors offer an anatomical and biomechanical explanation for the location of symptomatic amputation neuromas. The neuromas are found on the plantar surface proximal to the condyles of the metatarsal and medial to the interspace where the nerve is resected. The theory is based on intraoperative observations during surgery for recurrent neuromas and on cadaver dissections and offers a method based on this theory to reduce the number of recurrences.

scholarly journals Interdigital Perineural Fibroma And A Care Pathway.

2020 ◽  
Author(s):  
Mark Price ◽  
Andrew Bridgen
Keyword(s):  
Surgical Approach ◽  
Care Pathway ◽  
Treatment Options ◽  
Surgical Excision ◽  
Outcome Data ◽  
Mixed Methods Design ◽  
Morton’S Neuroma ◽  
Audit Data ◽  
Significant Difference ◽  
Morton's Neuroma

Abstract BackgroundInterdigital perineural fibroma (IPF) is a complex condition affecting the plantar nerve of the foot and the care pathway for its management is based upon a consensus of clinical opinions. AimThe aim of the study was to investigate the treatment outcomes within a podiatric surgical practice and produce a validated care pathway over a three-year period.MethodsA retrospective mixed methods design was used to allow combination of quantitative and qualitative data. 89 patients between 1/4/2014 and 1/4/2017 had completed PASCOM-10 audit data. The treatment options were investigated and the MOXFQ domains and PSQ10 outcome scores were subject to analysis with SPSS.FindingsThe mean age of patients in the study was 56 (range 36-86, SD 10.85) and 89% were female, 11% male. 749 patients out of the total caseload had local anaesthetic/steroid injections over the three-year period, of which 49% of the known injections were for Morton’s Neuroma. No outcome data was recorded for injections.89 patients went forward for surgical excision of the IPF. The surgical approach for excision was either dorsal (60.7%) or plantar (39.3%). All plantar incisions (transverse and linear) were analysed as a group for comparison against the dorsal approach. Using an independent t-test, there was no significant difference for dorsal or plantar approach or location of IPF across the three MOxFQ domains and PSQ10.Using a Pearson product moment correlation coefficient there was a moderately strong correlation between the PSQ10 and the MOxFQ domains (n=89, Walking and Standing: r=0.48, p<0.01; Pain: r=0.42, p<0.01; Social Interaction: r=0.40, p<0.01). Where increases in MOxFQ outcome score (amount of improvement) produces higher PSQ10 scores (greater patient satisfaction).ConclusionsMore audit data is required to assess the effectiveness of steroid and / or alcohol injections. Recommendation for practice is based on literature review. The surgical outcomes would suggest that the excision of IPF is an appropriate and effective technique and the surgical approach or location of pathology will not affect the clinical outcomes. A new care pathway for the management of IPF (Morton’s Neuroma) will be employed in practice and

Morton’s Neuroma Excision: What Are We Really Doing? Which Retractor Is Superior?

2018 ◽  
Vol 12 (3) ◽  
pp. 272-277
Author(s):  
Zachariah Pinter ◽  
Christopher Odom ◽  
Andrew McGee ◽  
Kyle Paul ◽  
Samuel Huntley ◽  
...  
Keyword(s):  
Cadaver Study ◽  
Common Complication ◽  
Morton’S Neuroma ◽  
Dorsal Approach ◽  
Levels Of Evidence ◽  
The Third ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Morton's Neuroma ◽  
The Mean

Background: When using a dorsal approach for Morton’s neuroma excision, the most common complication is recurrent Morton’s neuroma. The present cadaveric study demonstrates how far proximally the nerve is resected during a dorsal approach and examines both the laminar spreader and Gelpiretractor to determine which instrument facilitates maximal proximal resection of the nerve. Methods: This study involved 12 fresh-frozen cadaver specimens, each of which underwent a dorsal approach to the interdigital nerve with proximal resection. Either a laminar spreader or a Gelpi retractor was used to improve visualization of the intermetatarsal space. The interdigital nerve was then resected, and the lengths of the cut nerves were compared based on the retractor employed. Results: The mean length of proximal resection in the second intermetatarsal space was 2.42 cm when using the laminar spreader and 1.93 cm when using the Gelpi retractor (P = .252). In the third intermetatarsal space, the mean length of proximal resection was 2.14 cm when using the Laminar spreader and 1.48 cm when using the Gelpi retractor (P = .166). Conclusion: This study demonstrates how far proximal the interdigital nerve is resected during a dorsal approach to Morton’s neuroma and shows no statistically significant difference between the Laminar spreader and the Gelpi retractor. Levels of Evidence: Level V: Cadaver study

A Study of the Communicating Branch between the Medial and Lateral Plantar Nerves

Foot & Ankle ◽  
1984 ◽  
Vol 4 (6) ◽  
pp. 313-315 ◽  
Author(s):  
J. R. Jones ◽  
L. Klenerman
Keyword(s):  
Morton’S Neuroma ◽  
The Third ◽  
Communicating Branch ◽  
Morton's Neuroma

A study of the communicating branch between the medial and lateral plantar nerves was carried out on the feet of 20 cadavers. The nerve was found to be present in all the feet examined, but in two women it was considerably enlarged bilaterally. It is suggested that this enlarged communicating branch may be a factor responsible for the frequent involvement of the nerve to the third interspace by Morton's neuroma.

Deep Transverse Metatarsal Ligament Transection in Morton’s Neuroma Excision: A Cadaveric Study Examining Effects on Metatarsal Alignment

2017 ◽  
Vol 11 (4) ◽  
pp. 342-346
Author(s):  
Nathaniel Preston ◽  
Daniel Peterson ◽  
Jamey Allen ◽  
Jill S. Kawalec ◽  
Jeffrey Whitaker
Keyword(s):  
Test System ◽  
Cadaveric Study ◽  
Average Increase ◽  
Morton’S Neuroma ◽  
Intermetatarsal Angle ◽  
The Third ◽  
Significant Difference ◽  
Morton's Neuroma ◽  
The Relationship ◽  
Cycling Time

Background. In the dorsal incisional approach for Morton’s neuroma, it is required to transect the deep transverse metatarsal ligament (DTML) that lies in the interspace between the third and fourth metatarsal heads. The purpose of this study was to evaluate the relationship between transection of the DTML in the third intermetatarsal space and the metatarsal alignment. Methods. Nine human cadaveric lower extremity limbs were used for this study. Each limb was mounted to the MTS 858 Mini Bionix biomechanical test system and loaded to 120% of the donor’s documented body weight at a rate of 15 lbf/s, in order to simulate peak weightbearing ground reactive forces on the forefoot. Preoperative and immediate postoperative radiographs were obtained. Cyclic loading was then performed to simulate 1 month of full weightbearing. Radiographs were repeated and metatarsal alignment was analyzed. Results. A statistically significant difference was noted with intermetatarsal angle (IMA) 1-2 and IMA 1-4. The IMA 1-2 after 1 month cycling time showed statistical significant difference from those found immediately postoperatively (P < .05). Average increase in IMA 1-2 from preoperative to 1 month cycling time was 2.18°. The power of the analyses for IMA 1-2 was 0.992. Regarding the IMA 1-4, data recorded at 1 week and 1 month cycling times showed a statistically significant difference compared to the preoperative IMA 1-4 (P < .05). Average increase in IM 1-4 angles from preoperative to 1 month cycling time was an increase of 1.79°. The power of the analyses for IM 1-4 angles was 0.953. Conclusion. Technically, 2.18° increase in IMA 1-2 or 1.79° increase in IM 1-4 would be considered an abnormal widening of the forefoot, but clinically, these values could not be detected; nor should they deter a surgeon or patient from undergoing a Morton’s neurectomy via a dorsal incisional approach. Levels of Evidence: Level V: Cadaveric study

scholarly journals Ultrasound-guided treatment of Morton’s neuroma

2021 ◽  
Vol 21 (85) ◽  
pp. e134-e138
Author(s):  
Emmanouil Koltsakis ◽  
◽  
Michail E. Klontzas ◽  
George A. Kakkos ◽  
Apostolos H. Karantanas ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Sympathetic Innervation ◽  
Current Data ◽  
Accurate Diagnosis ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
The Third ◽  
Limited Efficacy ◽  
Plantar Aspect ◽  
Morton's Neuroma

Morton’s neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular degeneration, and deregulation of sympathetic innervation. Patients usually present with burning or sharp metatarsalgia at the dorsal or plantar aspect of the foot. The management of Morton’s neuroma starts with conservative measures, usually with limited efficacy, including orthotics and anti-inflammatory medication. When conservative treatment fails, a series of minimally invasive ultrasound-guided procedures can be employed as second-line treatments prior to surgery. Such procedures include infiltration of the area with a corticosteroid and local anesthetic, chemical neurolysis with alcohol or radiofrequency thermal neurolysis. Ultrasound aids in the accurate diagnosis of Morton’s neuroma and guides the aforementioned treatment, so that significant and potentially long-lasting pain reduction can be achieved. In cases of initial treatment failure, the procedure can be repeated, usually leading to the complete remission of symptoms. Current data shows that minimally invasive treatments can significantly reduce the need for subsequent surgery in patients with persistent Morton’s neuroma unresponsive to conservative measures. The purpose of this review is to present current data on the application of ultrasound for the diagnosis and treatment of Morton’s neuroma, with emphasis on the outcomes of ultrasound-guided treatments.

“The Feasibility of Targeted Muscle Reinnervation for the Management of Morton’s Neuroma”

2021 ◽  
pp. 193864002110027
Author(s):  
Shannon I. Kuruvilla ◽  
Christine V. Schaeffer ◽  
Minton T. Cooper ◽  
Brent R. DeGeorge
Keyword(s):  
Neuropathic Pain ◽  
Phantom Limb ◽  
Branch Points ◽  
Morton’S Neuroma ◽  
The Third ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Distal Edge ◽  
Morton's Neuroma ◽  
The Mean

Background Despite multiple surgical modalities available for the management of Morton’s neuroma, complications remain common. Targeted muscle reinnervation (TMR) has yet to be explored as an option for the prevention of recurrence of Morton’s neuroma. The purpose of the present investigation was to determine the consistency of the relevant foot neurovascular and muscle anatomy and to demonstrate the feasibility of TMR as an option for Morton’s neuroma. Methods The anatomy of 5 fresh-tissue donor cadaver feet was studied, including the course and location of the medial and lateral plantar nerves (MPNs and LPNs), motor branches to abductor hallucis (AH) and flexor digitorum brevis (FDB), as well as the course of sensory plantar digital nerves. Measurements for the locations of the muscular and sensory branches were taken relative to landmarks including the navicular tuberosity (NT), AH, FDB, and the third metatarsophalangeal joint (third MTPJ). Results The mean number of nerve branches to FDB identified was 2. These branch points occurred at an average of 8.6 cm down the MPN or LPN, 9.0 cm from the third MTPJ, 3.0 cm distal to AH distal edge, and 4.8 cm from the NT. The mean number of nerves to AH was 2.2. These branch points occurred at an average of 6.3 cm down the MPN, 11.9 cm from the third MTPJ, 0.8 cm from the AH distal edge, and 3.8 cm from the NT. Conclusions Recurrent interdigital neuroma, painful scar, and neuropathic pain are common complications of operative management for Morton’s neuroma. Targeted muscle reinnervation is a technique that has demonstrated efficacy for the prevention and treatment of neuroma, neuropathic pain, and phantom limb pain in amputees. Herein, we have described the neuromuscular anatomy for the application of TMR for the management of Morton’s neuroma. Target muscles, including the AH and FDB, have consistent innervation patterns in the foot, and consequently, TMR represents a viable option to consider for the management of recalcitrant Morton’s neuroma. Levels of Evidence: V

Ascorbic Acid does not Improve Endothelium-Dependent Flow-mediated Dilatation of the Brachial Artery in Patients with Raynaud’s Phenomenon Secondary to Systemic Sclerosis

2003 ◽  
Vol 73 (1) ◽  
pp. 3-7 ◽  
Author(s):  
M. E. Mavrikakis ◽  
J. P. Lekakis ◽  
M. Papamichael ◽  
K. S. Stamatelopoulos ◽  
Ch. C. Kostopoulos ◽  
...  
Keyword(s):  
Ascorbic Acid ◽  
Smooth Muscle ◽  
Systemic Sclerosis ◽  
Endothelial Dysfunction ◽  
Brachial Artery ◽  
Raynaud’S Phenomenon ◽  
Raynaud's Phenomenon ◽  
Water Soluble ◽  
Placebo Administration ◽  
Flow Mediated Dilatation

Previous studies have shown that patients with Raynaud’s phenomenon secondary to systemic sclerosis present abnormal endothelial function; the mechanisms responsible for the endothelial dysfunction are unknown but increased vascular oxidative stress could be a possible cause. The hypothesis that a potent water-soluble antioxidant can reverse endothelial dysfunction in these patients was tested in the present study. We examined 11 female patients with Raynaud’s phenomenon secondary to systemic sclerosis and ten healthy control women by ultrasound imaging of the brachial artery to assess flow-mediated (endothelium-dependent) and nitrate-induced (endothelium-independent) vasodilatation. Flow-mediated dilatation and nitrate-induced dilatation were significantly reduced in patients with Raynaud’s phenomenon, indicating abnormal endothelial and smooth muscle cell function. Patients with Raynaud’s phenomenon entered a double-blind, randomized, crossover placebo-controlled trial and received orally 2 g of ascorbic acid or placebo; vascular studies were repeated two hours after ascorbic acid or placebo administration. Flow-mediated dilatation did not improve after ascorbic acid (1.6 ± 2.2% to 2.2 ± 2.5%, ns) or placebo administration (1.2 ± 1,9% to 1.7 ± 1.4%, ns); also nitrate-induced dilatation was similar after ascorbic acid or placebo (16 ± 7.4% vs 17 ± 8%, ns), suggesting no effect of ascorbic acid on endothelial and vascular smooth muscle function. In conclusion, ascorbic acid does not reverse endothelial vasomotor dysfunction in the brachial circulation of patients with Raynaud’s phenomenon secondary to systemic sclerosis. The use of different antioxidants or different dosing of ascorbic acid may be required to show a beneficial effect on endothelial vasodilator function.

The response of skin perfusion and of rheological and immunological variables to intravenous prostanoid administration in Raynaud’s phenomenon secondary to collagenosis

VASA ◽  
2005 ◽  
Vol 34 (4) ◽  
pp. 243-249 ◽  
Author(s):  
Drinda ◽  
Neumann ◽  
Pöhlmann ◽  
Vogelsang ◽  
Stein ◽  
...  
Keyword(s):  
Laser Doppler Flowmetry ◽  
Raynaud’S Phenomenon ◽  
Raynaud's Phenomenon ◽  
Plasma Viscosity ◽  
Laser Doppler ◽  
Erythrocyte Aggregation ◽  
Control Group ◽  
Long Term Effects ◽  
Doppler Flowmetry

Background: Prostanoids are used in the treatment of Raynaud’s phenomenon and acral perfusion disorders secondary to collagenosis. In subjective terms, intravenous administration of these agents produces success in more than 50% of patients. The therapeutic outcome of clinical administration of alprostadil or iloprost may vary from individual to individual. Patients and methods: The following variables were analysed in a cross-over study in 27 patients with collagenosis and Raynaud’s phenomenon: plasma viscosity and erythrocyte aggregation (rheological variables), partial pressure of oxygen and laser Doppler flowmetry in the finger region, and lymphocyte phenotyping and interleukin (IL) determinations (immunological variables). Results: Laser Doppler flowmetry revealed significant differences between patients with secondary Raynaud’s phenomenon and a control group of 25 healthy subjects. Laser Doppler readings did not change significantly as a result of the treatments. Therapy with iloprost produced a reduction in IL-1beta, L-selectin (CD 62 L) and IL-6. Conclusion: The change in immunological variables due to iloprost may explain the long-term effects of prostaglandins in the treatment of Raynaud’s phenomenon. From our results it is not possible to infer any preference for iloprost or alprostadil.

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