Morton’s neuralgia, metatarsalgia

Česká verzia

Authors: J. Hradecký; E. Zvěřina; L. Mencl; P. Haninec
Authors place of work: 3. LF UK a FNKV v Praze ; Neurochirurgická klinika
Published in the journal: Cesk Slov Neurol N 2021; 84/117(2): 174-178
Category: Původní práce
doi: https://doi.org/10.48095/cccsnn2021174

Summary

Aim: Morton’s metatarsalgia was described 145 years ago and its treatment was implemented in the Czech Republic 42 years ago. This is a rare entrapment syndrome on the foot, which may lead to the inability to walk. Nevertheless, we did not find any evaluation of the operated collection of patients in our literature. The aim of the work is to make acquainted the readers with Morton’s metatarsalgia modern diagnosis and surgical treatment on the basis of the own set of patients. Patients and methods: The retrospective study includes 9 patients (8 women and 1 man) with a mean age of 47.4 years who were operated on between 2011 and 2017. The postoperative follow-up lasted 3–9 years. The diagnosis was determined by a clinical examination, tests, ultrasonography, MRI, and postoperative histology. The preoperative conservative therapy and pain lasted 1–10 (average of 3.3) year(s). Morton’s neuroma on the common plantar digital nerve was radically removed by the dorsal approach. Results: In seven patients, the neuroma was located in the area between the heads of the IIIrd and the IVth metatarsus. One female patient underwent resection in the space between the heads of the IInd and the IIIrd metatarsus. In one case, the neuroma occurred in both locations (between the heads of the IInd and the IIIrd and the IIIrd and the IVth metatarsus). The histological findings confirmed the clinical diagnosis of Morton’s neuroma. All operated patients, dysesthesia occurred, but only 5 patients were aware of changes in sensitivity. There was no recurrence in with 3–9 years. Preoperative pain according to the Numeric Rating Scale (NRS) was 5–7 (average 5.88). Postoperatively after 6 months, the pain reduced to 0–3 (on average 1.11) according to the NRS. Patients got back to normal walking and sports. Conclusion: The work demonstrates that Morton’s metatarsalgia can be successfully cured by the radical removal of the neuroma by the dorsal approach.

Keywords:

Morton´s metatarsalgia – Morton´s neuroma – neuroma – entrapment syndrome – Pain

Zdroje

1. Pasero G, Marson P. Filippo Civinini (1805–1844) and the discovery of plantar neuroma. Reumatismo 2006; 58(4): 319–322. doi: 10.4081/ reumatismo.2006.319.

2. Morton TG. A peculiar and painful affection of the fourth metatarso-phalangeal articulation. Am J Med Sci 1876; 71: 37–45.

3. Zvěřina E, Stejskal L. Poranění periferních nervů. Praha: Avicenum 1979.

4. Dungl P a kol. Ortopedie. Praha: Grada Publishing 2005.

5. Čihák R. Anatomie 3. Praha: Grada 1997.

6. Gougoulias N, Lampridis V, Sakellariou A. Morton’s interdigital neuroma: instructional review. EFORT Open Rev 2019; 4(1): 14–24. doi: 10.1302/ 2058-5241.4.180025.

7. Reichert P, Zimmer K, Witkowski J et al. Long-term results of neurectomy through a dorsal approach in the treatment of Morton’s neuroma. Adv Clin Exp Med 2016; 25(2): 295–302. doi: 10.17219/ acem/ 60249.

8. Jain S, Mannan K. The diagnosis and management of Morton’s neuroma: a literature review. Foot Ankle Spec 2013; 6(4): 307–317. doi: 10.1177/ 1938640013493464.

9. Tinel J. Nerve wounds. London: Bailliere, Tindall and Cox 1971.

10. Berry K. What is the role of EMG/ NCS in the diag-nosis of Morton neuroma? [online]. Available from URL: https:/ / www.medscape.com/ answers/ 308284-123908/ what-is-the-role-of-emgncs-in-the-diagnosis-of-morton-neuroma.

11. Xu Z, Duan X, Yu X et al. The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton’s neuroma: a systematic review. Clin Radiol 2015; 70(4): 351–358. doi: 10.1016/ j.crad.2014.10.017.

12. Pace A, Scammell B, Dhar S. The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop 2010; 34(4): 511–515. doi: 10.1007/ s00264-009-812-3.

13. Bardelli M, Turelli L, Scoccianti G. Definition and classification of metatarsalgia. J Foot Ankle Surg 2003; 9(2): 79–85. doi: 10.1016/ S1268-7731(02)00002-4.

14. Mulder JD. The causative mechanism in morton‘s metatarsalgia J Bone Joint Surg Br 1951; 33-B(1): 94–95. doi: 10.1302/ 0301-620X.33B1.94.

15. Morton‘s neuroma [online]. Available from URL: https:/ / www.physio-pedia.com/ Morton%27s_Neuroma.

16. Valisena S, Petri GJ, Ferrero A. Treatment of Morton‘s neuroma: a systematic review. Foot Ankle Surg 2018; 24(4): 271–281. doi: 10.1016/ j.fas.2017.03.010.

17. Lee J, Kim J, Lee M et al. Morton‘s neuroma (interdigital neuralgia) treated with metatarsal sliding osteotomy. Indian J Orthop 2017; 51(6): 692–696. doi: 10.4103/ 0019-5413.217678.

18. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005; 14(7): 798–804. doi: 10.1111/ j.1365-2702.2005.01121.x.

19. Coughlin MJ, Pinsonneault T. Operative treatment of interdigital neuroma: a long-term follow-up study. J Bone Joint Surg Am 2001; 83-A(9): 1321–1328.

20. Kasparek M, Schneider W. Surgical treatment of Morton’s neuroma: clinical results after open excision. Int Orthop 2013; 37(9): 1857–1861. doi: 10.1007/ s00264-013-2002-6.

21. Bucknall V, Rutherford D, MacDonald D et al. Outcomes following excision of Morton’s interdigital neuroma: a prospective study. Bone Joint J 2016; 98-B(10): 1376–1381. doi: 10.1302/ 0301-620X.98B10.37610.

22. Bae SY, Jung EY, Oh SC. Pyridoxine in the treatment of peripheral nerve related foot pain. J Korean Foot Ankle Soc 2013; 17: 203–208.

23. Akermark C, Crone H, Skoog A et al. A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton’s neuroma. Foot Ankle Int 2013; 34(9): 1198–1204. doi: 10.1177/ 1071100713484300.

24. Habashy A, Summarriva G, Treuting RJ. Neurectomy outcomes in patints with Morton neuroma: comparison of plantar vs dorsal approaches. Oschner J 2016; 16(4): 471–474.

25. Nashi M, Venkatachalam AK, Muddu BN. Surgery of Morton’s neuroma: dorsal or plantar approach? J R Coll Surg Edinb 1997; 42(1): 36–37.