OWL: OCOSH Classification/Foot Conditions/Mortons Neuroma

Interdigital Neuroma ELFAH

Barrie et al — 2007-10-28 11:13:42 GMT

Also known as Morton's metatarsalgia or Morton's neuroma, although Morton described neither (Morton thought this was a problem in the 4th MTP joint and Betts described the "neuroma" 70 years later).
The "neuroma" consists of degenerative and fibrotic changes in the common digital nerve near its bifurcation. However, there may be similar changes in adjacent unaffected nerves and it is not known why one becomes symptomatic. A number of causative factors have been suggested:
entrapment by the deep transverse metatarsal ligament
tethering of the 3rd space nerve by the anastomotic branch between medial and lateral plantar nerves
traction on the nerve by hindfoot valgus, interdigital bursitis or forced toe dosiflexion in high-heeled shoes

Interdigital Neuroma Mortons Neuroma

Starkey & Johnson — 2009-05-23 11:13:42 GMT

From Athletic Training & Sports Medicine By Chad Starkey, Glen Johnson.
Introducetion, Differential Diagnosis, Medical Diagnostic Tests, Imaging Techniques, Definitive Diagnosis, Pathomechanics and Functional Limitations, Immediate Management, Medications, Postinjury Management, Surgical Intervention, Postoperative Management,Injury Specific Treatment and Rehabilitation Concerns, Estimated Amount of Time Lost, Return-to-Play Criteria

Interventions for the treatment of Mortons Neuroma Cochrane

Not Available — 2009-05-23 11:13:42 GMT

There is insufficient evidence from randomised controlled trials to assess efficacy of surgical and non-surgical interventions for Morton's neuroma. More research is needed.
Morton's neuroma is a common, painful condition affecting the web spaces of the toes. Limited evidence from one randomised controlled trial indicated that surgery involving cutting the relevant nerve and implanting it into a muscle tendon may yield better long-term results than standard surgical removal of the nerve. There is little evidence from randomised controlled trials to support the use of insoles. There were no randomised controlled trials reporting the effect of corticosteroid injections. Adverse events following surgery were common. Well-designed trials are needed to guide clinical practice.

Morton Neuroma eMedicine Orthopedics

Schaller — 2008-03-20 11:13:42 GMT

Interdigital neuritis is a mechanically induced nerve irritation due to intrinsic and extrinsic biomechanical factors that results in a combination of pain, paresthesias, or numbness in the forefoot. A greater understanding of forefoot anatomy and biomechanics has created an environment to further delineate the pathophysiology of interdigital neuroma.
Synonyms and related keywords: interdigital neuroma, interdigital neuritis, forefoot pain, forefoot paresthesias, forefoot numbness, foot pain, Morton's neuroma
Author: Thomas M Schaller, MD 2004

Morton Neuroma eMedicine PMR

Gonzalez & Bowman — 2008-04-14 11:13:42 GMT

Morton neuroma (interdigital neuroma), first described in 1876, is a perineural fibrosis and nerve degeneration of the common digital nerve. Morton neuroma is not a true neuroma, although it results in neuropathic pain in the distribution of the interdigital nerve secondary to repetitive irritation of the nerve. The most frequent location is between the third and fourth metatarsals (third web space). Other less common locations are between the second and third metatarsals (second web space) and, rarely, between the first and second (first web space) or fourth and fifth (fourth web space) metatarsals. Episodes of pain are intermittent. Patients may experience 2 attacks in a week then none for a year. Recurrences are variable and tend to become more frequent. Between attacks, no symptoms or physical signs occur. Two neuromas rarely coexist on the same foot. Other diagnoses should be considered when 2 or more areas of tenderness are present.
Synonyms and related keywords: Morton's neuroma, Morton's metatarsalgia, interdigital neuroma, plantar neuroma, Morton metatarsalgia
Gonzalez & Bowman 2006

Morton Neuroma eMedicine Radiology

Needell & Cutler — 2009-05-23 11:13:42 GMT

Morton neuroma, or interdigital neuroma, is a common condition that involves enlargement of the interdigital nerve of the foot. Morton neuroma most commonly affects the third intermetatarsal space, but it can also affect the second intermetatarsal space, although it does so less often. Lesions in the fourth and first interspaces are unusual. The etiology remains controversial, and treatment varies among practitioners. Diagnosing the condition involves clinical judgment, and in difficult cases, imaging may be useful in determining the precise diagnosis.
Steven Needell, MD & Jonathan Cutler, DPM 2008

Morton's Neuroma Wheeless

Wheeless — 2002-01-31 11:13:42 GMT

Wheeless' Textbook of Orthopaedics
Morton's Neuroma: Interdigital Perineural Fibrosis
it is not a neuroma but a perineural fibrosis and it was not first accurately described by Morton but by Durlacher, a chiropodist in 1845; both Thomas G. Morton (1876) and Thomas K. Morton (1892) mistook it for a painful affection of the fourth MTP articulation
- it is a type of nerve compression syndrome which involves the common digital nerves of the lesser toes: most often 3rd (80-85 %) and less often the 2nd (15-20 %) interspace;
- interdigital neuromas do not occur in the 1st and 4th web space: consider other etiologies;
- the occurance of two interdigital neuromas is also very rare;
- occurs most often in middle aged women (78 % are women);

Mortons Neuroma TumorLibrary

James Johnston — 2010-06-07 11:13:42 GMT

Images of dissection and micrograph of resected neuroma.

Mortons Neuroma Wikidoc

Not Available — 2009-05-23 11:13:42 GMT

Morton's neuroma (also known as Morton's metatarsalgia, Morton's neuralgia, plantar neuroma and intermetatarsal neuroma) is a benign neuroma of the interdigital plantar nerve. This problem is characterised by numbness and pain, relieved by removing footwear. Although it is labeled a "neuroma", many sources do not consider it a true tumor, but rather a thickening of existing tissue.

Moton Neuroma

Miller & Nakra — 2009-05-23 11:13:42 GMT

Chapter 8 in McGlamry's Comprehensive Textbook of Foot and Ankle Surgery. Chapter by Miller & Nakra
Definition, Anatamy & Incidence, Diagnosis (Signs & Symptoms, Pain, Palpation, Differential Diagnosis), Diagnostic Tests (Radiographs, Sensory Nerve Conduction Tests), Histopathology, Etiology & Biomechanics, Conservative Management, Surgical Management
Some parts of this chapter are not available

Primary Interdigital Neuroma Resection

Turner & Kitaoka — 2009-05-23 11:13:42 GMT

Chapter 12 by Turner & Kitaoka in The foot and ankle By Harold B. Kitaoka, Deborah Ravin
Contents: Indications/Contraindications, Preoperative Planning, Surgery, Postoperative Management, Complications, Bibliography
Some pages are not available.

Treatment of Morton's Neuroma with Alcohol Injection Under Sonographic Guidance

Hughes et al — 2009-05-23 11:13:42 GMT

AJR 2007; 188:1535-1539 � American Roentgen Ray Society
Treatment of Morton's Neuroma with Alcohol Injection Under Sonographic Guidance: Follow-Up of 101 Cases
Richard J. Hughes, Kaline Ali, Hugh Jones, Sue Kendall and David A. Connell
We conclude that alcohol injection of Morton's neuroma has a high success rate and is well tolerated. The results are at least comparable to surgery, but alcohol injection is associated with less morbidity and surgical management may be reserved for nonresponders.