Is Morton's neuroma in a pes planus or pes cavus foot lead to differences in pressure distribution and gait parameters?

Morton's neuroma (MN) is a compressive neuropathy of the common digital plantar nerve causing forefoot pain. Foot posture and altered plantar pressure distribution have been identified as predispoing factors, however no studies have compared individuls with different foot postures with MN. Thus, we aimed to compare the effect of MN on spatiotemporal gait parameters and foot-pressure distribution in individuals with pes planus and pes cavus. Thirty-eight patients with unilateral MN were evaluated between June and August 2021. Nineteen patients with bilateral pes planus and 19 age and gender-matched patients with pes cavus who had no prior surgery were recruited. A Zebris FDM-THM-S treadmill system (Zebris Medical GmbH, Germany) was used to evaluate step length, stride length, step width, step time, stride time, cadence, velocity, foot-pressure distribution, force and whole stance phase, loading response, mid stance, pre-swing and swing phase percentages. There were no significant differences between the groups in spatiotemporal gait parameters (p > 0.05). Patients with pes planus displayed the following results for step length (49.36 ± 8.38), step width (9.05 ± 2.12), stance phase percentage (65.92 ± 2.11), swing phase percentage (34.08 ± 2.12), gait speed (2.96 ± 0.55), and cadence (100.57 ± 8.84). In contrast, patients with pes cavus displayed the following results for step length (49.06 ± 8.37), step width (8.10 ± 2.46), stance phase percentage (64.96 ± 1.61), swing phase percentage (34.79 ± 1.60), gait speed (2.95 ± 0.65), and cadence (99.73 ± 13.81). Foot-pressure distribution values showed no differences were detected in force, forefoot, and rearfoot pressure distribution, except for midfoot force (p < 0.05). The forefoot, midfoot, and rearfoot pressure values for the pronated group were 32.14 ± 10.90, 13.80 ± 3.03, and 22.78 ± 5.10, and for the supinated group were 33.50 ± 11.49, 14.23 ± 3.11 and 24.93 ± 6.52. MN does not significantly affect spatiotemporal gait parameters or foot-pressure distribution in patients with pes cavus or pes planus.

Rheumatoid nodule presenting as a Morton's neuroma in the foot: An important differential diagnosis to consider.

A 51-year-old lady with a background of rheumatoid arthritis presented to the foot and ankle clinic with pain and a typical history of Morton's neuroma. Examination revealed a palpable swelling over the right foot in the third intermetatarsal space. Following failed conservative management, the patient underwent excision of the neuroma. Histology revealed of necrotizing granulomas with peripheral palisading and no evidence of features specific to a neuroma. This has rarely been described previously and supports the concept of rheumatoid synovitis and nodules producing symptoms mimicking Morton's neuroma/metatarsalgia. Level of clinical evidence: 4.

Nerve decompression according to A.L. Dellon in Morton's neuroma - A retrospective analysis.

BACKGROUND: First reported by Dellon et al. in 1992, nerve decompression by dissecting the deep transversal intermetatarsal ligament through a dorsal incision appears to be a reliable method for treating Morton's neuroma by addressing its underlying pathomechanism, since it should rather be considered as Morton's entrapment. As there are no current studies dealing with Dellon's surgical technique, we carried out a retrospective analysis with the aim of showing that nerve decompression is an effective method to treat Morton's neuroma, and one that considers its true pathology. MATERIALS AND METHODS: All patients with a clinical diagnosis of Morton's neuroma, verified by MRI and treated by nerve decompression were included in this study in the years from 2010 to 2018 at our department. Follow-up was performed at least six months post-intervention; pain and function history were ascertained using the VAS (visual analogue scale) score and the German foot function index. Skin sensitivity testing was performed using Semmes-Weinstein monofilaments. RESULTS: A total of 12 patients were treated and followed-up during the study period. Postoperatively, there was significant improvement in the values of the VAS score both under strain (p-value: 0.0021) and at rest (p-value: 0.0062), as well as in the foot function index (p-value: 0.0022). There was no significant difference in skin sensitivity of the innervation areas of the interdigital nerves of the affected foot compared with the healthy reference foot (p-value: 0.0968). CONCLUSION: Dellon's decompression method yielded a highly positive outcome, and based on our findings, we consider it a reliable, technically simple and promising approach to treat Morton's neuroma. It is a minimally invasive technique that addresses the pathomechanism of peripheral nerve entrapment and has a low rate of complication as well as rapid patient recovery.

Sclerosing alcohol injections for the management of intermetatarsal neuromas: A systematic review.

An intermetatarsal neuroma is a plantar digital neuritis causing metatarsalgia of the affected inter-metatarsal space. At present the evidence to support the management of the condition is poor with only some quality evidence supporting the short-term management of intermetatarsal neuromas using steroid injections. Some authors have supported the use of alcohol sclerosing intra-lesional injections to treat intermetatarsal neuromas. Following a search of the evidence 11 articles were identified. The systematic review found that alcohol injections appear to be safe although some papers report a short-term side effect of a flogistic reaction and there are variances in the alcohol concentration used and guiding verses not guiding the injection using ultrasound imaging. Some of the evidence may suggest a sclerosing histological effect of the nerve. However, all the studies reviewed present a research design offering a low level of evidence that is open to methodological biases and interpretation. Thus, this review found insufficient high-quality research evidence to afford conclusions on the management of intermetatarsal neuromas with alcohol sclerosing agent injections.

Finite element analysis on relationship between wearing high-heeled shoes and stresses in intermetatarsal region of foot / 医用生物力学

Objective To study stress changes in forefoot intermetatarsal region when wearing high-heeled shoes, so as to provide references for quantitative analysis on inducement mechanism of intermetatarsal neuroma and corresponding treatment strategy. Methods Based on the validated foot-ankle-shoe finite element platform, changes of stress levels and tendency in intermetatarsal region were analyzed for both in balanced standing when wearing 0-3 inch (0, 2.54, 5.08, 7.62 cm) high-heeled shoes and walking when wearing 5.08 cm high-heeled shoes in a gait cycle. Results With the increase of heel height, the stresses in intermetatarsal region were significantly increased, and the stress in the third web space of toes when wearing 7.62 cm high-heeled shoes reached 312% of that when wearing flat shoes (0 cm high-heeled shoes). When walking with 5.08 cm high-heeled shoes, the third web space of toes at push-off instance had the largest stress, reaching 90 kPa, which agreed with the most commonly pathogenic site of intermetatarsal neuroma in clinic. Conclusions Wearing high-heeled shoes can obviously increase the stress in intermetatarsal region. Squeezing by upper extrusion of shoes can result in the largest stresses in the third web space of toes region, which is most likely to cause the development of intermetatarsal neuroma.

Therapeutic Massage Provides Pain Relief to a Client with Morton's Neuroma: A Case Report.

BACKGROUND: Morton's neuroma is a common cause of pain that radiates from between the third and fourth metatarsals and which, when symptomatic, creates sensations of burning or sharp pain and numbness on the forefoot. Many conservative and surgical interventions are employed to reduce associated pain, but not enough research has been conducted to recommend patients to any one approach as the most reliable source of pain management. PURPOSE: The objective of this case report is to describe the effect of massage therapy on one woman with symptomatic Morton's neuroma. PARTICIPANT: A physically active 25-year-old female with diagnosed symptomatic Morton's neuroma who has not found relief with previous conservative intervention. INTERVENTION: Six session of massage therapy once weekly for 60-75 minutes focused on postural alignment and localized foot and leg treatment. The client also completed an at-home exercise each day. Change was monitored each week by the massage therapist reassessing posture and by the client filling out a pain survey based on a Visual Analog Scale. RESULTS: The client reported progressive change in the character of the pain from burning and stabbing before the first session to a dull, pulsing sensation after the third session. She also recorded a reduction in pain during exercise from a 5/10 to 0/10 (on a scale where 10 is extreme pain). CONCLUSION: This study describes how massage therapy reduced pain from Morton's neuroma for one client; however, larger randomized control studies need to be done in order to determine the short- and long-term effects of massage therapy on this painful condition.