Physical Medicine and Rehabilitation for Morton Neuroma

Physical Medicine and Rehabilitation for Morton Neuroma

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Morton neuroma (interdigital neuroma), first described in 1876, is a perineural fibrosis and nerve degeneration of the common digital nerve. [1] Morton neuroma, or Morton’s 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 webspace). Other, less common locations are between the second and third metatarsals (second webspace) and, rarely, between the first and second (first webspace) or fourth and fifth (fourth webspace) metatarsals. [2, 3]

Episodes of pain are intermittent. Patients may experience 2 attacks in a week and then none for a year. Recurrences are variable and tend to become more frequent. Between attacks, no symptoms or physical signs occur. Two neuromas coexist on the same foot about 2-3% of the time. Other diagnoses should be considered when 2 or more areas of tenderness are present.

Interdigital nerves are composed of communicating branches from the lateral and medial plantar nerves. At the level of the metatarsal heads, the interdigital nerve traverses inferior to the intermetatarsal ligament. At this site, the nerve may be compressed or stretched from repetitive toe flexion and extension. Other studies have shown perineural fibrosis and demyelination at the level of the metatarsal heads, indicating that the damage in Morton’s neuroma may be more distal than the intermetatarsal ligament. [4]

United States

Morton’s neuroma is a common disease entity of the foot.

International

The incidence of Morton’s neuroma is presumed to be the same internationally as in United States.

The female-to-male ratio for Morton’s neuroma is 5:1.

The highest prevalence of Morton’s neuroma is found in patients aged 15-50 years, but the condition may occur in any ambulatory patient.

Morton TG. Peculiar painful affection of fourth metatarsophalangeal articulation. Am J Med Sci. 1876. 71:37.

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Valero J, Gallart J, Gonzalez D, Deus J, Lahoz M. Multiple interdigital neuromas: a retrospective study of 279 feet with 462 neuromas. J Foot Ankle Surg. 2015 May-Jun. 54 (3):320-2. [Medline].

Kim JY, Choi JH, Park J, et al. An anatomical study of Morton’s interdigital neuroma: the relationship between the occurring site and the deep transverse metatarsal ligament (DTML). Foot Ankle Int. 2007 Sep. 28(9):1007-10. [Medline].

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Mahadevan D, Venkatesan M, Bhatt R, Bhatia M. Diagnostic Accuracy of Clinical Tests for Morton’s Neuroma Compared With Ultrasonography. J Foot Ankle Surg. 2015 Jul-Aug. 54 (4):549-53. [Medline].

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Xu Z, Duan X, Yu X, Wang H, Dong X, Xiang Z. The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton’s neuroma: a systematic review. Clin Radiol. 2015 Apr. 70 (4):351-8. [Medline].

Ata AM, Onat SS, Ozcakar L. Ultrasound-Guided Diagnosis and Treatment of Morton’s Neuroma. Pain Physician. 2016 Feb. 19 (2):E355-8. [Medline]. [Full Text].

Bignotti B, Signori A, Sormani MP, Molfetta L, Martinoli C, Tagliafico A. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol. 2015 Aug. 25 (8):2254-62. [Medline].

Zanetti M, Weishaupt D. MR imaging of the forefoot: Morton neuroma and differential diagnoses. Semin Musculoskelet Radiol. 2005 Sep. 9(3):175-86.

Claassen L, Bock K, Ettinger M, Waizy H, Stukenborg-Colsman C, Plaass C. Role of MRI in detection of Morton’s neuroma. Foot Ankle Int. 2014 Oct. 35 (10):1002-5. [Medline].

Akermark C, Saartok T, Zuber Z. A prospective 2-year follow-up study of plantar incisions in the treatment of primary intermetatarsal neuromas (Morton’s neuroma). Foot Ankle Surg. 2008. 14(2):67-73. [Medline].

Monacelli G, Cascioli I, Prezzemolo G, Spagnoli A, Irace S. [Surgical treatment of Morton’s neuroma: our experience and literature review]. Clin Ter. 2008 May-Jun. 159(3):165-7. [Medline].

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Lee KT, Lee YK, Young KW, et al. Results of operative treatment of double Morton’s neuroma in the same foot. J Orthop Sci. 2009 Sep. 14(5):574-8. [Medline].

Bucknall V, Rutherford D, MacDonald D, Shalaby H, McKinley J, Breusch SJ. Outcomes following excision of Morton’s interdigital neuroma: a prospective study. Bone Joint J. 2016 Oct. 98-B (10):1376-81. [Medline].

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Title CI, Schon LC. Morton neuroma: primary and secondary neurectomy. J Am Acad Orthop Surg. 2008 Sep. 16(9):550-7. [Medline].

Pace A, Scammell B, Dhar S. The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop. 2010 Apr. 34(4):511-5. [Medline].

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Habashy A, Sumarriva G, Treuting RJ. Neurectomy Outcomes in Patients With Morton Neuroma: Comparison of Plantar vs Dorsal Approaches. Ochsner J. 2016 Winter. 16 (4):471-4. [Medline]. [Full Text].

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Lee J, Kim J, Lee M, Chu I, Lee S, Gwak H. Morton’s Neuroma (Interdigital Neuralgia) Treated with Metatarsal Sliding Osteotomy. Indian J Orthop. 2017 Nov-Dec. 51 (6):692-6. [Medline]. [Full Text].

Morgan P, Monaghan W, Richards S. A systematic review of ultrasound-guided and non-ultrasound-guided therapeutic injections to treat Morton’s neuroma. J Am Podiatr Med Assoc. 2014 Jul. 104 (4):337-48. [Medline].

Mahadevan D, Attwal M, Bhatt R, Bhatia M. Corticosteroid injection for Morton’s neuroma with or without ultrasound guidance: a randomised controlled trial. Bone Joint J. 2016 Apr. 98-B (4):498-503. [Medline].

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Yap LP, McNally E. Patient’s assessment of discomfort during ultrasound-guided injection of Morton’s neuroma: selecting the optimal approach. J Clin Ultrasound. 2012 May 15. [Medline].

Markovic M, Crichton K, Read JW, et al. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton’s neuroma. Foot Ankle Int. 2008 May. 29(5):483-7. [Medline].

Lizano-Diez X, Gines-Cespedosa A, Alentorn-Geli E, et al. Corticosteroid Injection for the Treatment of Morton’s Neuroma: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Trial. Foot Ankle Int. 2017 Sep. 38 (9):944-51. [Medline].

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Kevin Berry, MD Physical Medicine and Rehabilitation Physician, Rehabilitation Options of Issaquah

Kevin Berry, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society

Disclosure: Nothing to disclose.

Peter Gonzalez, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, Eastern Virginia Medical School

Peter Gonzalez, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Richard G Bowman, II, MD Rehabilitation and Electrodiagnostic Director, Physical Medicine and Rehabilitation, Pain Management, The Center for Pain Relief

Richard G Bowman, II, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Allergan<br/>Received honoraria from Allergan for speaking and teaching. for: Allergan.

Dean H Hommer, MD Chief, Department of Pain Management, Brooke Army Medical Center

Dean H Hommer, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Healthcare Executives, American College of Sports Medicine, American Institute of Ultrasound in Medicine, American Society of Interventional Pain Physicians, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Physical Medicine and Rehabilitation for Morton Neuroma

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