Morton's Neuroma / 대한정형외과학회잡지

Morton's neuroma, also known as interdigital neuroma, is a common cause of forefoot pain. It is a compressive neuropathy of the interdigital nerve, which is compressed by the overlying transverse metatarsal ligament. It is not a true tumor. The symptoms are forefoot pain that radiates into the toes, according to the involved nerve branches. Its histological findings are fibrosis around the nerve, demyelination. The clinical diagnosis can be obtained from a detailed history and physical examination, such as the compressive test. Moreover, ultrasonography and magnetic resonance imaging can also be used. Conservative treatment is the common initial treatment modality for interdigital neuroma. Surgical excision or decompression is indicated after a failure of conservative treatments.

Tratamento da neuropatia de Morton pela liberação do ligamento intermetatarsal / Treatment of Morton?s neuroma by intermetatarsal ligament

Entre agosto de 2005 e junho de 2006 17 pés, de 13 pacientes, foram submetidos ao tratamento do neuroma de Morton pela liberação do ligamento intermetatarsiano. Entrevista, exame clínico e exames de imagem (radiografia e ultrassonografia) foram realizados pré-operatoriamente e entrevista e exame clínico foram realizados na revisão, com uma média de 19 meses de seguimento. Resultados: Doze dos 13 pacientes operados estavam satisfeitos com a cirurgia, um deles com ressalvas pela persistência de sintomas residuais leves. Um paciente se apresentava insatisfeito no seguimento por não apresentar melhora com a cirurgia. Uma avaliação clínica específica foi utilizada: antes da cirurgia o escore médio foi de 14,1 pontos. O escore pós-operatório médio foi de 65,9 pontos, com uma melhora média de 51,8 pontos. Conclusão: Embora a causa da metatarsalgia de Morton permaneça obscura, os resultados preliminares deste trabalho reforçam a teoria de que a entidade seja uma neuropatia compressiva. O diagnóstico e a localização pré-operatória do neuroma de Morton podem ser realizados pelo exame ultrassonográfico e um resultado clínico favorável pode ser esperado sem remoção do segmento de nervo acometido em casos selecionados.

Anatomical Study of Interdigital Neuroma Occurring Site and the Deep Transverse Metatarsal Ligament (DTML) / 대한족부족관절학회지

PURPOSE: We examined the relationship of interdigital neuroma occurring site and the surrounding structures, including the deep transverse metatarsal ligament (DTML) by cadaver study and clinical results. MATERIALS AND METHODS: Seventeen fresh frozen cadavers study were done to evaluate the relationship of interdigital neuroma occuring site and the DTML at two phase of the gait cycle with 60 degree of metatarsophalangeal dorsiflexion and with 15 degrees of ankle dorsiflexion. We measured the distance from interdigital nerve bifurcation of the common digital nerve to anterior margin of the DTML and longitudinal length of DTML itself. Clinically, we checked the location of interdigital neuroma and DTML length during surgery in 32 feet. RESULTS: In the second and third web space, the mean distance from bifurcation of the common digital nerve of foot to the anterior margin of DTML was 16.7 mm, 15.1 mm in the mid-stance position, and 15.9 mm. 14.6 mm in heel-off position. Second, Third web space ligament itself length were average 12.8 mm, 10.6 mm. Clinically, all of the cases of interdigital neuroma started at the bifurcation area of the common digital nerve and interdigital neuroma was average 7.5 mm (range; 6-11 mm). CONCLUSION: Interdigital neuroma were located more distally than DTML in both the mid-stance and heel off stage. The main lesion was located between metatarsal head and metatarsophalangeal joint and more distal than the DTML anterior margin.

Factors Affecting on Conservative Treatment of Morton's Neuroma / 대한족부족관절학회지

PURPOSE: The purpose of this study was to investigate the clinical results of conservative treatment for Morton's neuroma and to analyze the factors which influenced on the results. MATERIALS AND METHODS: In this retrospective study, 101 cases of 83 patients with interdigital neuroma were conservatively treated with follow-up period of at least 6 months. There was no significant difference in results among different age groups, sxes, and lesion sites. However, the results were significantly better if the treatment was started within 6 months after onset. RESULTS: We had 28 excellent results (28%), and 13 good results (13%). Patients were grouped by sex, age, duration of symptom before treatment, affected location. The result of treatment was evaluated by comparing the subject pain and discomfort score of the first vist and last follow-up. CONCLUSION: There are excellent results over 41% by conservative treatment. The results of conservative treatment were not related to age, sex, and lesion site, but were related to pre-treatment period. The shorter the pretreatment period was, the better the results.

Clinical Results of Conservative Treatment for Interdigital Neuroma / 대한족부족관절학회지

PURPOSE: The purpose of this study is to evaluate the effectiveness of low-dose gabapentin for interdigital neuroma. MATERIALS AND METHODS: Between April 2000 and June 2003, 32 patients (39 feet) with interdigital neuroma were treated with using low-dose gabapentin. Two of the 32 patients were male, and thirty were female, and the average age was 47.4 years. The follow-up was 6 to 44months (mean 15.1 months). All cases were diagnosed by physical examination and ultrasonography or MRI. Low-dose gabapentin (300-600 mg) was prescribed and shoe modification was recommended. The patients were evaluated through questionnaire. RESULTS: Neuroma was found in twenty one cases at the third intermetatarsal space, and thirteen at the second intermetatarsal space. The sensitivity of ultrasonography was 96% and that of MRI was 79%. Overall satisfaction was rated as excellent or good by 18 cases (57%). Average pain relief ratio was 50.3%, and in 14 cases, more than 80% of pain relief was noted. Nine (28%) of 32 patients showed they had no activity restrictions, such as daily activities or work, whereas 8 (25%) had mild restrictions and 15 (47%) had major restrictions. Twelve of 15 patient with major restrictions had been treated operatively (neurectomy; 10 cases, decompression; 2 cases). One case had gastrointestinal problem. CONCLUSION: Low-dose gabapentin for interdigital neuroma was one of the effective conservative treatments. The operation may be preserved for patient with the persist symptoms, nevertheless the conservative treatments and use of low-dose gabapentin.