Efficacy of a Single Corticosteroid Injection for Morton's Neuroma in Adults: A Systematic Review.

BACKGROUND: Morton's neuroma is a common condition that routinely presents in podiatric practice. The aim of this study was to systematically synthesize the evidence relating to the effectiveness of a corticosteroid injection for Morton's neuroma. METHODS: Studies with a publication date of 1960 or later were eligible, and searches were performed within the Turning Research Into Practice database; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register; MEDLINE (Ovid); PubMed; Embase; Cumulative Index to Nursing and Allied Health Literature; and the gray literature. Study selection criteria included randomized and nonrandomized controlled trials where a single corticosteroid injection for Morton's neuroma pain was investigated. The primary outcome was Morton's neuroma pain as measured by any standard validated pain scale. RESULTS: Ten studies involving 695 participants were included. The quality of the studies was considered low and subject to bias. Of the included studies, five compared corticosteroid injection to usual care, one compared corticosteroid injection to local anesthetic alone, one compared ultrasound-guided to non-ultrasound-guided injections, three compared corticosteroid injections to surgery, one compared small to large neuromas, six assessed patient satisfaction, four measured adverse events, one studied return to work, and one examined failure of the corticosteroid injection to improve pain. Overall, these studies identified a moderate short- to medium-term benefit of corticosteroid injections on the primary outcome of pain and a low adverse event rate. CONCLUSIONS: A single corticosteroid injection appears to have a beneficial short- to medium-term effect on Morton's neuroma pain. It appears superior to usual care, but its superiority to local anaesthetic alone is questionable, and it is inferior to surgical excision. A very low adverse event rate was noted throughout the studies, indicating the intervention is safe when used for Morton's neuroma. However, the quality of the evidence is low, and these findings may change with further research.

Efficacy of a single botulinum toxin A injection for distal tarsal tunnel syndrome: A protocol for a randomized, double-blinded trial.

INTRODUCTION: Distal tarsal tunnel syndrome (DTTS) is characterised by compression of the tibial nerve as it passes underneath the abductor hallucis muscle belly. There is no current consensus on treatment for DTTS. This study was conducted to compare and evaluate the effect of ultrasound-guided botulinum toxin A (BTX-A) versus ultrasound-guided corticosteroid injection (CSI) for the treatment of DTTS. METHODS: This study was a single-centre, randomized, and double-blinded trial. The study protocol was submitted to the local ethics committee board and subsequently registered in a research registry. 88 patients with DTTS were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 12 weeks. Evaluation was via the Foot Health Status Questionnaire (FHSQ). The primary outcome measures were pain and the secondary outcomes were function and the use of oral analgesics. All of the assessments were performed at baseline and at 3, 6, and 12 weeks after treatment. RESULTS: This is a randomized controlled trial evaluating the efficacy of BTX-A versus CSI in the treatment of DTTS. This study has limited inclusion and exclusion criteria and a well-controlled intervention. CONCLUSIONS: The results of this trial will provide more evidence on which method can better treat DTTS. TRIAL REGISTRATION: We have registered this trial with the Australian New Zealand Clinical Trials Registry and the temporary trial number is 380,105.

Plantar vein thrombosis.

Plantar vein thrombosis is an uncommon and under-diagnosed cause of plantar foot pain. It is characterized by the formation of a blood clot (thrombus) within one of the plantar veins. Factors leading to this condition are unclear and multiple potential causes have been proposed. Plantar vein thrombosis presents as non-specific unilateral plantar foot pain, swelling, and a heavy feeling in the affected foot. There is no current diagnostic guideline for this condition however compression ultrasound and magnetic resonance imaging appear suitable. Treatments range from rest and non-steroidal anti-inflammatory drugs to six months of anticoagulant therapy. Herein, we aim to consolidate the current literature on plantar vein thrombosis to guide clinicians and future researchers.

Plantar vein thrombosis masquerading as plantar fasciitis: A case report.

Plantar vein thrombosis is an uncommon and under-diagnosed cause of plantar foot pain characterised by the formation of a blood clot (thrombus) within one of the plantar veins. There is no current diagnostic guideline for this condition however compression ultrasound and magnetic resonance imaging appear suitable. Treatments range from rest and non-steroidal anti-inflammatory drugs to six months of anticoagulant therapy. A 51-year old female was referred reporting a two-week history of left heel pain suspicious of plantar fasciitis. Ultrasonography and Magnetic Resonance Imaging showed thickening and expansion of the lateral plantar vein. The patient's symptoms disappeared following two weeks of non-steroidal anti-inflammatory medication and compression therapy, and follow-up ultrasound six weeks later showed recanalisation of the lateral plantar vein.

Radical Cheilectomy as an Alternative to Arthrodesis for Hallux Rigidus.

Hallux rigidus (HR) is a painful condition involving osteoarthrosis and reduced range of motion of the first metatarsophalangeal joint (MTPJ). It is associated with significant morbidity and reduced quality of life. We report a case of a 42-year-old female who had been referred to our surgical clinic regarding the progressively worsening chronic pain, stiffness and long-term shoe-fitting difficulties associated with her right HR pathology. Her vocational duties within the fashion industry necessitated the use of high heeled court-style shoes, and thus she maintained a preference for a procedure that would facilitate normal joint range of motion so that she could continue to wear this type of footwear. We performed a variation to a traditional cheilectomy procedure involving radical remodelling of the first metatarsal head to allow for up to 90 degrees of intraoperative dorsiflexion. The patient reported reduced pain and increased function up until her discharge at 12 weeks postoperatively. A radical cheilectomy may provide acceptable pain relief and improved joint function in patients with end-stage HR who decline the option of arthrodesis.

A Case of Polymetatarsia Without Polydactyly.

Polymetatarsia is an atavistic anomaly characterised by one or more additional metatarsals. Usually found with a supernumerary digit (polydactyly), polymetatarsia without polydactyly is a rare variant. We report a case of a 34-year-old male with polymetatarsia within the first intermetatarsal spaces of both feet without polydactyly. Clinically, moderate dorsal spur formation was visible, and compressive pain from ankylosed additional metatarsals within the first intermetatarsal spaces was exhibited. Treatment involved resection of his additional metatarsals with concomitant correction of his hallux valgus deformities and bilateral second brachymetatarsia. He reported a reduction in pressure and pain that was maintained until his discharge appointment at six weeks postoperatively. Resection of additional metatarsals may provide effective pain relief in symptomatic patients.

Surgical management of an enchondroma of the proximal phalanx of the foot: An illustrative case report.

Enchondromas are benign tumours that may become symptomatic due to expansive pressure on the surrounding bone. In this case, a 27-year-old male developed a symptomatic enchondroma within the proximal phalanx of his left fourth toe. Resection and insertion of a bone graft were considered optimal management. Histopathology testing confirmed the diagnosis of an isolated enchondroma. The patient was monitored closely for 3 months postoperatively and reported full satisfaction at his 12-month review. Enchondroma resection and insertion of a tibial bone graft may provide an effective long-term solution for a symptomatic enchondroma of the toe.

Surgical Realignment of a Dorsiflexed Metatarsal Fracture.

Metatarsal fractures are common injuries that routinely present to outpatient clinics. Whilst usually amenable to conservative care, there is controversy regarding treatment when the fracture results in significant misalignment. In this case report, a 54-year-old female recreational basketball player who sustained a second metatarsal fracture that had healed in a dorsiflexed position in relation to the adjacent metatarsals was referred for a surgical opinion. She had experienced worsening overload pain to her third metatarsophalangeal joint (MTPJ). Open reduction with internal fixation (ORIF) via a 6-hole locking plate was employed to reduce the fracture misalignment and re-establish the metatarsal parabola. She enjoyed an uneventful recovery with a full return to her sporting activities. ORIF with locking plate may be an acceptable technique for reducing displaced metatarsal fractures and re-establishing the metatarsal parabola.

A Morton's Neuroma Invading the Proper Digital Nerve.

We report a case of a 55-year-old female with extreme right fourth toe pain of unknown origin that was resistant to conservative care. Resection confirmed invasion of the neuroma into the fourth digit with hypertrophy and herniation of the proper digital nerve. The patient experienced an uneventful recovery with some minor neurogenic symptoms experienced at six months postoperatively that resolved with off-loading padding and heat massage. Complete pain relief was reported at her 12-month review. Isolated neuroma within a toe results in digital pain that may respond to excision.

Capsular Interposition Arthroplasty With Percutaneous Suture Anchoring: A Pragmatic and Novel Surgical Technique for Hallux Rigidus.

There is support for the use of capsular interposition arthroplasty (CIA) as an alternative to arthrodesis in the surgical treatment of hallux rigidus. In this technical report, the authors describe novel technical variations to the traditional capsular interposition arthroplasty that are anatomically rational, reproducible, and efficient. This technique was developed by the primary author and has been the preferred approach to CIA for over 10 years. The key technical differences of the procedure are metatarsal head preparation, the use of a proximally based capsular graft, and anchoring by utilizing a simple percutaneous anchoring technique. This approach maintains anatomic joint morphology, preserves vascular supply, and bone stock to facilitate future procedures if required.