scholarly journals The interphalangeal angle as a novel radiological measurement tool for Morton’s neuroma – a matched case-control study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Martin Zaleski ◽  
Timo Tondelli ◽  
Sandro Hodel ◽  
Dominic Rigling ◽  
Stephan Wirth
Keyword(s):  
Area Under The Curve ◽  
Measurement Tool ◽  
X Rays ◽  
Morton’S Neuroma ◽  
Intermetatarsal Angle ◽  
Radiological Measurement ◽  
History Of ◽  
Morton's Neuroma ◽  
Matched Case ◽  
Magnetic Resonance Imaging Mri

Abstract Background The aim of this retrospective study was to examine if a correlation between Morton’s Neuroma (MN) and an increased interphalangeal angle (IPA) or intermetatarsal angle (IMA) can be found in preoperative weightbearing dorsal-plantar X-rays of the foot. Methods Forty-five patients with forty-nine MN in the interspaces 2/3 or 3/4 and 49 controls were recruited for this study. Every MN was matched with an asymptomatic control without history of metatarsalgia. The diagnosis was made by clinical examination, magnetic resonance imaging (MRI) and positive histopathology after operative resection. IMA 1/5, 2/3, 2/4, 2/5, 3/4 and IPA 2/3, 3/4 were measured for both groups. Results The IPA 3/4 was significantly enlarged by 2.8 degrees (p < 0.001) with Area under the curve (AUC) 0.75 (p < 0.001), sensitivity of 73% and specificity of 67% in feet with MN compared to controls. The IMA 3/4 was significantly enlarged by 1 degree (p < 0.048) with AUC 0.64 (p < 0.031), sensitivity of 71% and specificity of 43% in feet with MN compared to controls. No difference between IMA 2/4, 2/5, 1/5 or correlation between IPA or IMA and the size of the MN in the MRI was found. Conclusion The results confirm the clinical observation of an increased IPA in patients with MN. An increased IPA should therefore be considered in the diagnosis of MN.

scholarly journals Synovial Chondromatosis in the Metacarpophalangeal Joint

2018 ◽  
Vol 4 ◽  
pp. 2513826X1775111
Author(s):  
Casey Thorburn ◽  
John Hopkins ◽  
Donald Cook ◽  
Shane Seal
Keyword(s):  
Metacarpophalangeal Joint ◽  
Synovial Chondromatosis ◽  
Joint Effusion ◽  
High Signal ◽  
X Rays ◽  
Surgical Exploration ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Relative Scarcity ◽  
Firm Mass

Synovial chondromatosis (SC) is a benign proliferative metaplasia of joint synovium into cartilaginous tissue. The relative scarcity of presentation in the wrist or hands contributes to the difficulties in accurately diagnosing and obtaining the necessary treatment for SC. We present a 43-year-old man with a 10-month history of stiffness and decreased range of motion of his right first metacarpophalangeal (MCP) joint. On examination, a firm mass was palpated surrounding his MCP joint. X-rays showed only a joint effusion. Subsequent magnetic resonance imaging (MRI) showed an effusion, high signal intensity joint distension, and small erosions. Surgical exploration and complete synovectomy with excision of loose bodies was performed. The pathological diagnosis, based on the clinical examination as well as MRI, was consistent with that of tenosynovial chondromatosis. This case illustrates surgical exploration and pathological investigations may be necessary for SC diagnosis. The literature was reviewed for greater understanding of SC’s presentation, diagnosis, and treatment.

Sex Correlation to the Prevalence of Pedal Neuromas in Various Interspaces: A Retrospective Study

2020 ◽  
Vol 110 (5) ◽  
Author(s):  
Patrick A. DeHeer ◽  
Artinder P. Nanrhe ◽  
Shannon R. Michael ◽  
Sarah N. Standish ◽  
Christine D. Bhinder ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Statistical Significance ◽  
Special Focus ◽  
Morton’S Neuroma ◽  
Nerve Branch ◽  
Plantar Plate ◽  
Significant Difference ◽  
History Of ◽  
Morton's Neuroma ◽  
Male Patients

Background Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and in females. The principal investigator observed Morton's neuromas commonly in the second and third interspaces in both sexes. To our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each sex independently. The present study evaluates Morton's neuroma interspace location and whether there is a variation by sex. Methods In this retrospective study, 582 deidentified magnetic resonance imaging reports with a diagnosis code for Morton's neuroma were evaluated for patients scanned from January 2, 2015, through April 19, 2016. Incomplete records and those with radiologist findings inconsistent with Morton's neuroma were eliminated. For the remaining 379 patients, data were collected on sex, laterality, history of trauma, plantar plate tear, age, and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data were evaluated using the Pearson χ2 and independent-samples Mann-Whitney U tests, with P &lt; .05 indicating statistical significance. Results No statistically significant distribution between sex and second and third interspace Morton's neuromas was noted. Right vs left foot, age, and history of trauma did not vary statistically significantly between sexes. There was a statistically significant difference between the presence of plantar plate tears between sexes. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (P = .01). Conclusions This study found that there were no statistically significant differences between sexes and Morton's neuromas location, laterality, or age.

Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton’s Neuroma

2017 ◽  
Vol 39 (2) ◽  
pp. 201-204 ◽  
Author(s):  
Kang Lee ◽  
Il-Yeong Hwang ◽  
Chang Hyun Ryu ◽  
Jae Woo Lee ◽  
Seung Woo Kang
Keyword(s):  
Hyaluronic Acid ◽  
Case Series ◽  
Functional Improvement ◽  
X Rays ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Level Of Evidence ◽  
Hyaluronic Acid Injection ◽  
Acid Injection ◽  
Morton's Neuroma

Background: Morton’s neuroma is one of the common causes of forefoot pain. In the present study, hyaluronic acid injection was performed on patients to determine the efficacy and adverse effects of hyaluronic acid in management of Morton’s neuroma. Methods: Eighty-three patients with Morton’s neuroma in their third intermetatarsal space with definite Mulder’s click were included in the study. Those with severe forefoot deformities such as forefoot cavus or hallux valgus on plain X-rays were excluded. Ultrasound-guided hyaluronic acid injections were performed on all patients weekly for 3 weeks. Pain during walking using visual analogue scale (VAS) and AOFAS Forefoot Scale were prospectively evaluated preinjection, and at 2, 4, 6, 12 months postinjection. Results: Significant improvement in VAS and AOFAS Forefoot Scale were seen overall at 2 months after hyaluronic acid injections ( P < .05). Then, there were almost no changes after 4 months, continuing until 12 months. The mean VAS was decreased from 73.1 initially to 23.0 at 12 months and AOFAS Forefoot Scale was increased from 32.2 to 86.5. There were no complications which occurred. Conclusion: In the present study, ultrasound-guided hyaluronic injection was clinically effective for pain relief and functional improvement for at least 12 months in patients with Morton’s neuroma. However, numbness associated with Morton’s neuroma should be addressed more cautiously since it may persist without much improvement. Level of Evidence: Level IV, retrospective case series.

Metatarsus Primus Elevatus in Hallux Rigidus

2005 ◽  
Vol 95 (3) ◽  
pp. 221-228 ◽  
Author(s):  
Thomas S. Roukis
Keyword(s):  
Hallux Valgus ◽  
Plantar Fasciitis ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Radiographic Measurement ◽  
Morton’S Neuroma ◽  
Significant Difference ◽  
History Of ◽  
Morton's Neuroma ◽  
Grade Ii

Two hundred seventy-five lateral weightbearing radiographs of isolated pathology were reviewed and stratified into hallux rigidus (n = 100), hallux valgus (n = 75), plantar fasciitis (n = 50), and Morton’s neuroma (n = 50) groups. The patient population consisted of healthy individuals with no history of foot trauma or surgery. The first to second metatarsal head elevation, Seiberg index, first to second sagittal intermetatarsal angle, first to fifth metatarsal head distance, and hallux equinus angle were measured in each population. Statistically significant differences were found between the hallux valgus, plantar fasciitis, and Morton’s neuroma populations and the hallux rigidus population, which showed greater elevation of the first metatarsal relative to the second for each radiographic measurement technique. In the hallux rigidus population, there was a statistically significant difference between grade II and grades I and III regarding the first to fifth metatarsal head distance (greater in grade II) and the hallux equinus angle (lower in grade II). A review of the literature and comparison with historical controls reveals that metatarsus primus elevatus exists in hallux rigidus and is greater than that found in hallux valgus, plantar fasciitis, and Morton’s neuroma groups. (J Am Podiatr Med Assoc 95(3): 221–228, 2005)

Radiographic Analysis of Feet With and Without Morton’s Neuroma

2016 ◽  
Vol 38 (3) ◽  
pp. 310-317 ◽  
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.

scholarly journals Systemic Mastocytosis Associated with “Smoldering” Multiple Myeloma

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 88
Author(s):  
Magda Zanelli ◽  
Stefano Ricci ◽  
Maurizio Zizzo ◽  
Francesca Sanguedolce ◽  
Federica De Giorgi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cells ◽  
Systemic Mastocytosis ◽  
Elevated Serum ◽  
Cell Lineage ◽  
Right Hemicolectomy ◽  
X Rays ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Marrow Cellularity

A 79-year-old woman presented with a long history of peripheral eosinophilia. Previous right hemicolectomy for colonic polyposis was reported. Laboratory tests were notable for mild macrocitic anaemia and eosinophilia. β2 microglobulin and serum tryptase levels were elevated. Serum immunofixation revealed IgA/kappa monoclonal protein. Bence-Jones protein was positive. Bone marrow (BM) biopsy revealed the coexistence of two neoplastic components. Cohesive clusters of bland-looking, spindle-shaped mast cells, representing 20% of marrow cellularity, were close to aggregates of mature plasma cells occupying 40% of marrow cellularity. Molecular analysis on marrow aspirate demonstrated KIT D816V mutation, TET2 mutation, monoallelic deletion of TP53/17p13 and trisomy of ATM/11q23. A bone density study revealed mild osteoporosis. Full skeletal X-rays and magnetic resonance imaging (MRI) of spine and hips showed multiple, small rarefaction areas and an old L1-L2 fracture, both ascribed to osteoporosis. The association of systemic mastocytosis (SM) and multiple myeloma (MM) is very uncommon. The coexistence of SM with MM placed our patient in the SM with associated clonal haematological non-mast-cell lineage disease (SM-AHN) subtype. Midostaurin therapy was started.

scholarly journals Gender Correlation to the Prevalence of Pedal Neuromas in Various Interspaces - A Retrospective Study

2020 ◽  
Author(s):  
Patrick A DeHeer ◽  
Artinder P Nanrhe ◽  
Shannon R Michael ◽  
Sarah N Standish ◽  
Christine D Bhinder ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Statistical Significance ◽  
Special Focus ◽  
Morton’S Neuroma ◽  
Chi Square ◽  
Nerve Branch ◽  
Plantar Plate ◽  
Significant Difference ◽  
History Of ◽  
Morton's Neuroma

BACKGROUND: Morton's neuromas are abnormalities of the common digital nerve branch located between the lesser metatarsal heads. Historically, interdigital (Morton's) neuromas have been characterized as being most common in the third interspace and predominantly identified in females. The principal investigator observed Morton's neuromas commonly in both the 2nd and 3rd interspaces in both genders. To the best of our knowledge, no literature exists to evaluate Morton's neuroma location with a focus on each gender independently. The present study evaluates Morton's neuroma interspace location and if there is a variation between males and females.METHODS: In this retrospective study, 582 de-identified ProScan magnetic resonance imaging reports, with a diagnosis code for Morton's neuroma (ICD Code 355.6), were obtained from their centralized database. These reports were evaluated for patients scanned from January 2015-April 2016. Incomplete records and those where the radiologist findings were not consistent with Morton's neuroma were eliminated. For the remaining 379 patients, data was collected on several factors such as gender, laterality, history of trauma, plantar plate tear, age and interspace location. Special focus was given to second and third interspace Morton's neuromas. Data was then evaluated statistically utilizing the Pearson Chi-Square and Independent Samples Mann-Whitney U Test with statistical significance deemed p&lt;0.05. RESULTS: No statistically significant distribution between gender and second and third interspace Morton's neuromas were noted. Additionally, right vs left foot, age and history of trauma did not vary between genders in a significant way. Lastly, there was a statistically significant difference between the presence of plantar plate tears between genders. Male patients with Morton's neuromas were found to have a higher rate of plantar plate tears (34/92, p=0.01).CONCLUSION: Our study found that there was not a statistically significant difference between female and male and Morton's neuromas location, laterality or age.

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

Lipofibromatous Hamartoma of the Plantar Nerve

2018 ◽  
Vol 108 (2) ◽  
pp. 182-185 ◽  
Author(s):  
Murat Mert ◽  
Payam Hacısalihoglu
Keyword(s):  
Soft Tissue ◽  
Motor Deficits ◽  
Flexor Hallucis Longus ◽  
Tarsal Tunnel ◽  
Morton’S Neuroma ◽  
Rare Benign Tumor ◽  
Lipofibromatous Hamartoma ◽  
History Of ◽  
Morton's Neuroma

Lipofibromatous hamartoma (LFH) is a rare, benign, tumor-like soft-tissue lesion that affects the peripheral nerves and forms a palpable neurogenic mass. Lipofibromatous hamartoma is associated with pain and sensory and/or motor deficits in the area of innervation of the affected nerve. This report describes a rare case of LFH of the plantar nerve. A 48-year-old woman presented to our outpatient orthopedic clinic with pain and a burning sensation on her left foot. The patient had a history of Morton's neuroma and had undergone a tarsal tunnel operation 2 years earlier at another center. None of her symptoms was alleviated by two previous operations. Magnetic resonance imaging with contrast revealed tenosynovitis of the flexor hallucis longus tendon and signal changes at deep tissue planes of the foot at the levels of the second and third toes, on the dorsal site and subcutaneous soft-tissue planes, suggesting edema and Morton's neuroma. The lesion was excised under spinal anesthesia, and histopathologic examination of the specimen revealed a diagnosis of LFH. The patient was discharged without any symptoms and her foot was normal at 8-month outpatient follow-up, with no indications of postoperative complications and/or recurrence.

Chronic Injury of Distal Tibiofibular Syndesmosis with Ankle Fracture Dislocation: A Case Report

2020 ◽  
Author(s):  
Ehsan Mahmoud ◽  
Mohammad Hossein Nabian
Keyword(s):  
Treatment Plan ◽  
Skin Condition ◽  
Fracture Dislocation ◽  
X Rays ◽  
Joint Stability ◽  
Chronic Injury ◽  
Syndesmosis Injury ◽  
Tibiofibular Joint ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Background: Syndesmotic injury is one of the major causes of ankle pain and arthritis in athletes. Syndesmotic instability may remain undetectable when occurring with ankle fractures.Case Report: A 59-year-old man presented to the orthopedic clinic with a history of surgery for fracture-dislocation of ankle two months before his visit. During revision surgery, we performed an open reduction, tension band wiring (TBW), and syndesmotic screw fixation. The results were satisfactory, with an almost full ankle range of motion (ROM) and good skin condition. Conclusion: Early diagnosis and treatment of syndesmosis injury can prevent the complications such as chronic pain, osteoarthritis (OA), and stiffness. There is no consensus on the treatment of syndesmosis injury, but the main factors in determining the treatment plan are tibiofibular joint stability or instability and the amount of time that the injury has occurred. Magnetic resonance imaging (MRI) and computed tomography (CT) can also be used in addition to X-rays in cases of suspected syndesmosis injury

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