Physical Medicine and Rehabilitation for Morton Neuroma Workup

  • Author: Kevin Berry, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Mar 30, 2010
 

Laboratory Studies

No laboratory studies are indicated for the diagnosis of Morton's neuroma.

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Imaging Studies

Results of plain films are normal in Morton's neuroma.

Ultrasonography, although not often used, may detect Morton's neuroma, but it has questionable reliability.[5]

Computed tomography (CT) scanning has been used but may not be as sensitive as magnetic resonance imaging (MRI).

  • MRI, while not needed in most cases for establishing diagnosis of Morton's neuroma, has been studied widely.[6]
  • Sensitivity of 87% and specificity as high as 100% have been reported. Asymptomatic neuromas may occur and confound accurate diagnosis.

Indications exist that Morton's neuromas smaller than 5 mm in diameter may not be significant clinically and that other diagnoses may be excluded carefully before such a small lesion is diagnosed as a symptomatic Morton's neuroma. Imaging with T1 weighting in a coronal plane is recommended for best visualization. In addition, on T2 imaging, the low signal of a Morton's neuroma may help to differentiate it from a true neuroma, ganglion cyst, or intermetatarsal bursal fluid collection.

Contrast enhancement usually is demonstrated with Morton's neuromas.

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Other Tests

Electromyography and nerve conduction study (EMG/NCS) of Morton's neuroma are not used often because of the technical difficulty in performing the them; needle stimulation of the common digital nerve and pickup on the adjacent toe or toes, which may be of short distance, is required. Surface stimulation results most often in volume conduction through the skin to the pickups because of the short distance involved and the large amount of stimulation needed to penetrate the deep tissue separating the nerve from the skin surface.

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Procedures

Temporary elimination of pain and numbness in the associated webspace by a common digital nerve block with an anesthetic agent supports a diagnosis of Morton's neuroma. If numbness of the associated webspace occurs but no decrease in pain is noted, other diagnoses should be considered.

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Histologic Findings

Tissue biopsy is neither needed nor recommended for Morton's neuroma.

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Contributor Information and Disclosures
Author

Kevin Berry, MD  Resident Physician, Physical Medicine and Rehabilitation Department, University of Colorado Hospital

Kevin Berry, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Medical Student Association/Foundation, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Peter Gonzalez, MD  Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine

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, and 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.

Specialty Editor Board

Robert J Kaplan, MD  James E Van Zandt VA Medical Center, Staff Physician, Department of Rehabilitation Medicine

Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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, and Association of Academic Physiatrists

Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

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

  2. Fridman R, Cain JD, Weil L Jr. Extracorporeal shockwave therapy for interdigital neuroma: a randomized, placebo-controlled, double-blind trial. J Am Podiatr Med Assoc. May-Jun 2009;99(3):191-3. [Medline].

  3. 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. Sep 2007;28(9):1007-10. [Medline].

  4. O'Connor FG, Wilder RP, Nirschl R. Foot Injuries in the Runner. In:Textbook of Running Medicine. New York: McGraw-Hill; 2001;258-260.

  5. Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee JW, et al. Morton neuroma: evaluated with ultrasonography and MR imaging. Korean J Radiol. Mar-Apr 2007;8(2):148-55. [Medline].

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

  7. 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].

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

  9. Valente M, Crucil M, Alecci V. Operative treatment of interdigital Morton's neuroma. Chir Organi Mov. May 2008;92(1):39-43. [Medline].

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

  11. Villas C, Florez B, Alfonso M. Neurectomy versus neurolysis for Morton's neuroma. Foot Ankle Int. Jun 2008;29(6):578-80. [Medline].

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

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

  14. Rout R, Tedd H, Lloyd R, et al. Morton's neuroma: diagnostic accuracy, effect on treatment time and costs of direct referral to ultrasound by primary care physicians. Qual Prim Care. 2009;17(4):277-82. [Medline].

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

  16. Betts LO. Morton's Metatarsalgia. Med J Aust. 1940;1:514.

  17. Clanton TO, Butler JE, Eggert A. Injuries to the metatarsophalangeal joints in athletes. Foot Ankle. Dec 1986;7(3):162-76. [Medline].

  18. Cyriax J. Diagnosis of soft tissue lesions.In: Textbook of Orthopaedic Medicine. 8th ed. Philadelphia, Pa:. The Curtis Center;1982.

  19. Guiloff RJ. Carbamazepine in Morton's neuralgia. Br Med J. Oct 13 1979;2(6195):904. [Medline].

  20. Jahss MH, Kummer F. Non-inflammatory synovitis of the second metatarsophalangeal joint and its surgical management. Paper read at: 16th Annual Meeting of American Orthopaedic Foot Ankle Society, New Orleans, La. February 1986.

  21. Logan PM, Janzen DL, O'Connell JX, et al. Magnetic resonance imaging and histopathologic appearances of benign soft-tissue masses of the foot. Can Assoc Radiol J. Feb 1996;47(1):36-43. [Medline].

  22. Mizel MS, Miller RA, Scioli MW. Orthopaedic knowledge update. In: Foot and Ankle. Rosemont, Ill:. American Academy of Orthopaedic Surgeons;1998.

  23. Snyder RK. In: Essentials of Musculoskeletal Care. Rosemont, Ill:. American Academy of Orthopedic Surgeons;1997.

  24. Terk MR, Kwong PK, Suthar M, et al. Morton neuroma: evaluation with MR imaging performed with contrast enhancement and fat suppression. Radiology. Oct 1993;189(1):239-41. [Medline].

  25. Vazquez-Abad D, Tian L, Monteon V, et al. CRI-EM is a human idiotype highly specific for scleroderma. Ann N Y Acad Sci. Apr 5 1997;815:512-5. [Medline].

  26. Wu KK. Morton neuroma and metatarsalgia. Curr Opin Rheumatol. Mar 2000;12(2):131-42. [Medline].

  27. Yocum LA. In: Clinics in Sports Medicine. Vol 7. Philadelphia, Pa:. WB Saunders Co;1988.

 
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Plantar view showing the relationships between the metatarsal heads, the intermetatarsal ligament, and the neuroma.
Neurectomy: typical incision location.
Neurectomy: superficial exposure.
Neurectomy: deeper dissection.
Neuroma and adherent fibrofatty tissue.
 
 
 
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