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Interdigital neuroma

Tun Hing Lui
Morton's neuroma is a compressive neuropathy resulting in perineural fibrosis rather than a neuroma of the plantar digital nerve. Surgical treatment is indicated for patients with a clear diagnosis of Morton's neuroma and no improvement with nonsurgical treatment. The surgical options include isolated intermetatarsal ligament division, isolated interdigital nerve excision, and interdigital nerve excision with intermetatarsal ligament division, with or without submuscular transposition. This can be performed via dorsal or plantar approach...
August 2017: Arthroscopy Techniques
Joonho Lee, Jeongyo Kim, Myoungjin Lee, Intak Chu, Sungjae Lee, Heuichul Gwak
Background: Morton's neuroma is a common cause of metatarsalgia and many treatments had been described in literature. However, there have been only a few reports that treat the neuroma with an osteotomy on the proximal, not distal portion of the metatarsal bone using a plate. This study describes the clinical outcome of sliding osteotomy on the proximal metatarsal bone for the treatment of Morton's neuroma. Materials and Methods: Sixty five consecutive patients (85 feet) who underwent surgery for Morton's neuroma between November 2010 and February 2013 were identified from hospital records to include in this retrospective study...
November 2017: Indian Journal of Orthopaedics
Tun Hing Lui
Plantar plate deficiency is the major pathology causing metatarsophalangeal joint instability. As the joint subluxates dorsally, the lumbrical is tethered at the medial side of the joint by the deep metatarsal ligament and becomes a deforming force for the development of crossover toe deformity. Plantar plate repair or reconstruction is a logical surgical treatment option. This can be performed through a dorsal or plantar approach. The purpose of this technical note is to report a minimally invasive technique of crossover toe deformity correction by suturing the plantar plate to the extensor tendon...
December 2016: Arthroscopy Techniques
Ravi Kanth Mallina, Khalid Al-Dadah, Kirtan Patel, Pal Ramesh
BACKGROUND: Interdigital neuroma (IN), otherwise known as Morton's neuroma, is a common cause of metatarsalgia presenting to the elective foot and ankle clinic. Surgical excision of the IN in patients who fail to respond to nonoperative measures is considered to be the gold standard of care in many centers. The Royal College of Pathologists UK recommend that all excised interdigital Morton's neuromas are sent for formal histopathological analysis. We present a study correlating clinical and radiological diagnosis with histopathologic appearances of IN following surgical excision, and question if routine histopathological analysis is warranted...
December 2017: Foot & Ankle Specialist
Takumi Matsumoto, Song Ho Chang, Naohiro Izawa, Yohei Ohshiro, Sakae Tanaka
The entrapment theory is the most commonly accepted theory concerning the development of interdigital neuroma; it incriminates the deep transverse metatarsal ligament as the major causative factor of the condition. This report presents a patient with interdigital neuroma in the second intermetatarsal space, which was strongly suspected to be caused by the metatarsophalangeal joint instability due to plantar plate injury. Surgical intervention revealed that the neuroma was located more distally and dorsally than the deep transverse metatarsal ligament and was pinched between the adjacent metatarsal heads, suggesting the involvement of the metatarsophalangeal joint instability and chronic trauma as etiologies in this case...
2016: Case Reports in Orthopedics
V Bucknall, D Rutherford, D MacDonald, H Shalaby, J McKinley, S J Breusch
AIMS: This is the first prospective study to report the pre- and post-operative patient reported outcomes and satisfaction scores following excision of interdigital Morton's neuroma. PATIENTS AND METHODS: Between May 2006 and April 2013, we prospectively studied 99 consecutive patients (111 feet) who were to undergo excision of a Morton's neuroma. There were 78 women and 21 men with a mean age at the time of surgery of 56 years (22 to 78). Patients completed the Manchester-Oxford Foot Questionnaire (MOXFQ), Short Form-12 (SF-12) and a supplementary patient satisfaction survey three months pre-operatively and six months post-operatively...
October 2016: Bone & Joint Journal
Jeffrey A Strakowski
Ultrasound guidance allows real-time visualization of the needle in peripheral nerve procedures, improving accuracy and safety. Sonographic visualization of the peripheral nerve and surrounding anatomy can provide valuable information for diagnostic purposes and procedure enhancement. Common procedures discussed are the suprascapular nerve at the suprascapular notch, deep branch of the radial nerve at the supinator, median nerve at the pronator teres and carpal tunnel, lateral cutaneous nerve of the thigh, superficial fibular nerve at the leg, tibial nerve at the ankle, and interdigital neuroma...
August 2016: Physical Medicine and Rehabilitation Clinics of North America
Charles Yang, Elaine S Gould, Maryanna Mason
We present the case of a 20-year-old man with the chief complaint of right foot pain for the past three years presenting with focal bony prominence at dorsomedial aspect of right mid foot with interdigital pain. MRI demonstrated a metatarsal coalition with interdigital neuroma.
2009: Radiology Case Reports
Stefan N van Vendeloo, Harmen B Ettema
Steroid injection is frequently used in the treatment of interdigital neuroma and has a high rate of success. We report the case of a patient who develops skin depigmentation at the injection site and linear streaks of depigmentation over the foot, the ankle and half way up to the knee after a steroid injection for interdigital neuroma. Minor disadvantages such as subcutaneous fat atrophy and depigmentation of the skin at the injection site are well known problems following steroid injection. Depigmentation of the skin with a lymphatic distribution in the foot after steroid injection for interdigital neuroma however, has not yet been reported before...
June 2016: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Robert G Parker, Orlando Merced-O'Neil
Painful recurrent stump neuroma presents a common clinical problem following the transection of a nerve after initial interdigital neuroma excision but there is no gold standard of treatment. A patient presented with pain symptoms consistent with recurrent intermetatarsal stump neuroma after undergoing previous surgery to excise a Hauser neuroma. The recurrent stump neuroma was excised and the resulting nerve was capped and implantation into intrinsic muscle. Postoperatively, the patient experienced a complete resolution of pain and return of normal function...
April 2016: Clinics in Podiatric Medicine and Surgery
Tugrul Ormeci, Olcay Güler, Melih Malkoc, Mert Keskinbora, Fatma Zeynep Güngören, Mahir Mahirogulları
The objective of the present study was to characterize the ultrasound and elastographic properties of intermetatarsal neuroma (interdigital neuroma) and their contribution to diagnosis. Eighteen patients with metatarsalgia, who had presented to an orthopedic clinic from April 2013 to February 2015, were diagnosed with 25 intermetatarsal neuromas (11 unilateral [61.11%], 7 bilateral [38.89%]). These patients underwent evaluation with ultrasonography and simultaneous ultrasound strain elastography to assess the elastographic properties of the tissues in the intermetatarsal space...
July 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Ayşe Merve Ata, Şule Şahin Onat, Levent Özçakar
Morton's neuroma is the fibrous enlargement of the interdigital nerve branches, usually in the second and third interspace between the metatarsal heads where the lateral and medial plantar nerves often join. Specific symptoms are dull or sharp pain, numbness and/or tingling in the third and fourth digits, burning sensation, cramping, and a feeling of "walking on a stone" around the metatarsal heads. Numerous clinical tests for Morton's neuroma have been described, such as thumb index finger squeeze, and Mulder's click and foot squeeze tests...
February 2016: Pain Physician
Kathryn M O'Connor, Jeffrey E Johnson, Jeremy J McCormick, Sandra E Klein
BACKGROUND: Diagnosis of an interdigital neuroma (IDN) is clinically based on patient symptoms. During operative excision, it is common to send the excised specimen for routine histopathologic examination. The purpose of this study was to evaluate the accuracy of the clinical and intraoperative diagnosis of IDN and correlate these with the histopathologic results of IDN. METHODS: Case logs of 3 fellowship-trained foot and ankle surgeons were reviewed to identify all neuroma excisions completed between 1997 and 2014...
January 2016: Foot & Ankle International
Chamnanni Rungprai, Christopher C Cychosz, Ongart Phruetthiphat, John E Femino, Annunziato Amendola, Phinit Phisitkul
BACKGROUND: Simple neurectomy is a standard treatment of interdigital nerve neuroma after failure of conservative treatment. Recently, neurectomy with intramuscular implantation of the proximal nerve stump has been proposed as a safe and effective alternative method providing significant pain improvement. However, there remains little evidence supporting one technique over the other. The purpose of this study was to compare functional outcomes and complications of simple neurectomy versus neurectomy with intramuscular implantation...
December 2015: Foot & Ankle International
Gordon Lee, Euicheol Jeong
In this report, we present a case of toe reconstruction with a medial sural artery perforator free flap after failure of replantation. A 35-year-old male suffered a crush injury from a heavy object falling over the left 1st, 2nd, and 3rd toes and underwent microsurgical replantation of the toes at an outside facility. Over the next 2 weeks, ischemic necrosis of all the toes developed. This condition was very frustrating for the patient who had very high expectations of preserving the toes, and also for the surgeon to determine the optimal method to reconstruct the distal foot and toes...
February 2016: Microsurgery
Roberto Sergio Martins, Mario Gilberto Siqueira, Carlos Otto Heise, Lin Tchia Yeng, Daniel Ciampi de Andrade, Manoel Jacobsen Teixeira
BACKGROUND: Painful neuroma following amputation is a disabling condition for which treatments are not usually satisfactory. The aim of this study is to retrospectively evaluate the results of interdigital neurorrhaphy after neuroma resection as an option for the surgical treatment of painful digital neuroma. METHOD: We retrospectively analyzed data from seven patients submitted to interdigital neurorrhaphy for treatment of digital neuroma. For evaluation of the results, the visual analog scale (VAS) for pain assessment, measurements with Simmens-Weinstein filaments and a handgrip dynamometer, and quantification of the Disabilities of the Arm, Shoulder and Hand (DASH) score were all performed...
April 2015: Acta Neurochirurgica
Shinji Isomoto, Yasuhito Tanaka
Morton's disease refers to neuralgia at the web space of the toes with a pseudo-neuroma. It commonly occurs in the third web space of the foot in middle-aged and older women. The pseudo-neuroma is thought to be a secondary change after entrapment or repeated microtrauma. Patients complain of forefoot pain while walking. Typically, symptoms are caused by tight high-heeled shoes. The physical examination includes palpation of the web spaces and Mulder's test. Weight bearing foot radiographs are used to evaluate the deformity of the foot, especially at metatarsophalangeal (MTP) joints...
December 2014: Brain and Nerve, Shinkei Kenkyū No Shinpo
David R Richardson, Erin M Dean
Interdigital neuromas are a common cause of forefoot pain, and approximately 80% of patients require surgical excision for symptom relief. Although 50% to 85% of patients obtain relief after primary excision, symptoms may recur because of an incorrect diagnosis, inadequate resection, or adherence of pressure on a nerve stump neuroma. The symptom relief rate after reoperation is similar to that after primary excision. A plantar longitudinal incision provides optimal exposure, and transposition of the nerve stump into bone or muscle and avoids traction or pressure on the nerve ending that can result in a painful stump neuroma...
September 2014: Foot and Ankle Clinics
José Valero, José Gallart, David González, Javier Deus, Manuel Lahoz
Morton's neuroma is a common pathologic entity that, traditionally, was considered to be an isolated tumor that rarely affected more than 1 interdigital space. However, in recent years, multiple neuromas have become more common in our day-to-day practice. The objective of the present study was to assess the frequency with which Morton's neuroma appears in the different interdigital spaces. A retrospective study was performed of 279 feet that had been surgically treated for Morton's neuroma using a dorsal approach during a 9-year period (from January 2003 to December 2011), with an ultrasound scan taken preoperatively and histopathologic analysis performed afterward...
May 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
José Manuel Pardal-Fernández, Elena Palazón-García, Francisco Hernández-Fernández, Carlos de Cabo
BACKGROUND: Morton's neuroma causes metatarsalgia due to the interdigital neuropathy. The small nerve diameter compromises their evaluation in image studies. To overcome this problem we propose a new electrophysiological test. METHODS: We conducted a prospective case-control study performing a orthodromic electroneurography using subdermal electrodes in controls and patients to assess the validity. Additionally all patients were tested with magnetic resonance. Some patients required surgery and subsequent histological evaluation...
June 2014: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
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