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.

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

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

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.

Effectiveness of Ultrasound-Guided Corticosteroid Injection in the Treatment of Morton's Neuroma

2008 ◽  
Vol 29 (5) ◽  
pp. 483-487 ◽  
Author(s):  
Maja Markovic ◽  
Ken Crichton ◽  
John W. Read ◽  
Peter Lam ◽  
Henry Kim Slater
Keyword(s):  
Corticosteroid Injection ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Morton's Neuroma

Minimally invasive neurectomy for Morton’s neuroma with Interdigital approach. Long term results

The Foot ◽  
2021 ◽  
pp. 101808
Author(s):  
Héctor José Masaragian ◽  
Fernando Perin ◽  
Leonel Rega ◽  
Nicolas Ameriso ◽  
Luciano Mizdraji ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Long Term Results ◽  
Morton’S Neuroma ◽  
Morton's Neuroma

scholarly journals Patient Related Outcome Measures (PROMs) in Morton’s Neuroma: Conservative vs. Surgical Management at One-Year Follow-Up

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0002
Author(s):  
Alastair Faulkner ◽  
Alistair Mayne ◽  
Fraser Harrold
Keyword(s):  
Outcome Measures ◽  
Surgical Management ◽  
Conservative Management ◽  
Morton’S Neuroma ◽  
Significant Difference ◽  
Morton's Neuroma ◽  
One Year ◽  
Patient Related Outcome ◽  
Eq Vas

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

Multiple neuromas coexisting with rheumatoid synovitis and a rheumatoid nodule

2000 ◽  
Vol 90 (5) ◽  
pp. 252-255 ◽  
Author(s):  
LA Zielaskowski ◽  
SJ Kruljac ◽  
JJ DiStazio ◽  
S Bastacky
Keyword(s):  
Rare Case ◽  
Relevant Literature ◽  
Rheumatoid Nodule ◽  
Morton’S Neuroma ◽  
Forefoot Pain ◽  
Rheumatoid Nodules ◽  
Morton's Neuroma ◽  
The Many

The authors present a rare case of multiple intermetatarsal neuromas coexisting with rheumatoid synovitis and a rheumatoid nodule. A brief review of rheumatoid nodules as a source of forefoot pain and a review of the relevant literature are provided. A rheumatoid nodule is just one of the many diagnoses that must be considered when one encounters pedal symptoms similar to those associated with Morton's neuroma.

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