Instrumental and clinical diagnosis of interdigital Morton neuroma

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Abstract

Background: Interdigital neuroma is one of the most common diseases in foot surgery. It is a common cause of metatarsalgia leading to debilitating pain. At the same time, the diagnosis of neuroma can be a difficult task for an orthopedic surgeon due to the complex anatomy of the forefoot and a large number of soft-tissue and bone structures. Besides, the existing manual testing methods are not pathognomonic specifically for neuroma. The clinical symptoms and history, as well as a physical exam and instrumental evidence are important in assessing and grading the disease. However, there are no recommendations in the modern Russian literature regarding the need for routine visualization of neuroma. The reproducibility of the study, the absence of ionizing radiation and the possibility of obtaining a second opinion, as well as high sensitivity makes magnetic resonance imaging an important diagnostic tool in the diagnosis of neuroma. Aim: To evaluate the importance of the anamnesis and complaints and the sensitivity of clinical tests and magnetic resonance imaging of the foot in the diagnosis of interdigital neuromas. Methods: The study presents a retrospective analysis of the medical histories and outpatient records of 28 patients (8 men and 20 women) treated at the EMC ECSTO in the period from 2017 to 2022. The examination was performed according to a standardized protocol: collection of complaints and anamnesis, palpation, manual testing, including Mulder's click test. As a part of examination, magnetic resonance imaging of the foot was performed for all the patients. The average patient’s age at the time of the surgical treatment was 45 years. The resection of a part of the affected nerve with the subsequent histological examination was considered a gold standard for the treatment and verification of interdigital neuromas. In all the cases, the histopathological study confirmed the diagnosis. Results: The sensitivity of magnetic resonance imaging in the diagnosis of interdigital neuromas was 86%, the sensitivity of the Mulder test was 61%. Pain during the palpation of the affected interdigital space was determined in 100% of cases. Conclusion: The combination of a manual examination and magnetic resonance imaging, along with the analysis of complaints and anamnesis makes it possible to diagnose Morton's neuroma in most cases.

About the authors

Daria A. Bolshakova

European Clinic of Sports Traumatology and Orthopaedics; Peoples' Friendship University of Russia

Author for correspondence.
Email: dasha.bolsh@gmail.com
ORCID iD: 0009-0003-3332-9267

Graduate Student

Russian Federation, Moscow; Moscow

Andrey A. Kardanov

European Clinic of Sports Traumatology and Orthopaedics

Email: akardanov@emcmos.ru
ORCID iD: 0000-0003-2866-2295
SPIN-code: 5134-8123

MD, PhD

Russian Federation, Moscow

Musa N. Maysigov

European Clinic of Sports Traumatology and Orthopaedics

Email: mmaysigov@emcmos.ru
ORCID iD: 0000-0002-2096-5876

MD, PhD

Russian Federation, Moscow

Alexander А. Akhpashev

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: akhpashev@gmail.com
ORCID iD: 0000-0002-2938-5173
SPIN-code: 9965-1828

MD, PhD

Russian Federation, Moscow

Dmitriy O. Ilyin

European Clinic of Sports Traumatology and Orthopaedics; Peoples' Friendship University of Russia

Email: ilyinshoulder@gmail.com
ORCID iD: 0000-0003-2493-4601
SPIN-code: 7947-5121

MD, PhD, Assistant Professor

Russian Federation, Moscow; Moscow

Andrey V. Korolev

European Clinic of Sports Traumatology and Orthopaedics; Peoples' Friendship University of Russia

Email: akorolev@emcmos.ru
ORCID iD: 0000-0002-8769-9963
SPIN-code: 6980-6109

MD, PhD, Professor

Russian Federation, Moscow; Moscow

References

  1. Urits I, Smoots D, Franscioni H, et al. Injection techniques for common chronic pain conditions of the foot: A comprehensive review. Pain Ther. 2020;9(1):145–160. doi: 10.1007/s40122-020-00157-5
  2. Colò G, Rava A, Samaila EM, et al. The effectiveness of shoe modifications and orthotics in the conservative treatment of Civinini-Morton syndrome: State of art. Acta Bio Medica Atenei Parmensis. 2020;91(4S):60–68. doi: 10.23750/abm.v91i4-S.9713
  3. Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006;77(2):263–265. doi: 10.1136/jnnp.2005.066696
  4. Menz HB, Dufour AB, Katz P, Hannan MT. Foot pain and pronated foot type are associated with self-reported mobility limitations in older adults: The framingham foot study. Gerontology. 2016;62(3):289–295. doi: 10.1159/000442089
  5. Siefkas AC, Dufour AB, Golightly YM, et al. Foot pain and inflammatory markers: A cross sectional study in older adults. J Foot Ankle Res. 2022;15(1):57. doi: 10.1186/s13047-022-00565-0
  6. Bhatia M, Thomson L. Morton’s neuroma: Current concepts review. J Clin Orthop Trauma. 2020;11(3):406–409. doi: 10.1016/j.jcot.2020.03.024
  7. Слиняков Л.Ю., Бобров Д.С., Ригин Н.В., и др. Основные принципы диагностики перегрузочной метатарзалгии в поликлинической практике // Кафедра травматологии и ортопедии. 2015. № 3. С. 21–24. [Slinyakov LYu, Bobrov DS, Rigin NV, et al. Basic principles of diagnosis of overload metatarsalgia in polyclinic practice. Kafedra travmatologii i ortopedii. 2015;(3):21–24. (In Russ).]
  8. Шайхутдинов И.И., Масгутов Р.Ф., Валеева Л.Р., Ягудин Р.Х. Неврома Мортона как причина болей в стопе: диагностика и тактика лечения // Практическая медицина. 2016. № 4-1. С. 182–186. [Shaikhutdinov II, Masgutov RF, Valeeva LR, Yagudin RKh. Morton’s neuroma as a cause of pain in the foot, diagnostics and methods of treatment. Practical Medicine. 2016;(4-1):182–186. (In Russ).]
  9. Albtoush OM, Xenitidis T, Horger M. Intermetatarsal bursitis as first disease manifestation in different rheumatological disorders and related MR-imaging findings. Rheumatol Int. 2019;39(12):2129–2136. doi: 10.1007/s00296-019-04381-x
  10. Angelini A, Bevoni R, Biz C, et al. Schwannoma of the foot: Report of four cases and literature review. Acta Biomed. 2019; 90(Suppl. 1):214–220. doi: 10.23750/abm.v90i1-S.8079 Andrea A. et al. Schwannoma of the foot: report of four cases and literature review // Acta Biomed. 2019. Vol. 90, № Suppl 1. P. 214–220.
  11. Malta JN, Martins J, Azenha A, Pereira PL. Diagnostic and therapeutic challenge of metatarsalgia in a patient with rheumatoid arthritis. Cureus. 2022;14(1):e21751. doi: 10.7759/cureus.21751
  12. Hulstaert T, Shahabpour M, Provyn S, et al. Forefoot pain in the lesser toes: Anatomical considerations and magnetic resonance imaging findings. Can Assoc Radiol J. 2019;70(4):408–415. doi: 10.1016/j.carj.2019.06.010
  13. Goud A, Khurana B, Chiodo C, Weissman BN. Women’s musculoskeletal foot conditions exacerbated by shoe wear: An imaging perspective. Am J Orthop (Belle Mead NJ). 2011;40(4):183–191.
  14. Hassouna H, Singh D. Morton’s metatarsalgia: Pathogenesis, aetiology and current management. Acta Orthop Belg. 2005;71(6):646–655.
  15. 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
  16. Larson EE, Barrett SL, Battiston B, et al. Accurate nomenclature for forefoot nerve entrapment: A historical perspective. J Am Podiatric Med Assoc. 2005;95(3):298–306. doi: 10.7547/0950298
  17. Thompson FM, Deland JT. Occurrence of two interdigital neuromas in one foot. Foot Ankle. 1993;14(1):15–17. doi: 10.1177/107110079301400103
  18. Valero J, Gallart J, González D, et al. Multiple interdigital neuromas: A retrospective study of 279 feet with 462 neuromas. J Foot Ankle Surg. 2015;54(3):320–322. doi: 10.1053/j.jfas.2014.05.011
  19. Ригин Н.В. Хирургическое лечение перегрузочной метатарзалгии при эластичных деформациях стоп: Автореф. дис. ... канд. мед. наук. Москва, 2020. 25 с. [Rigin NV. Surgical treatment of overload metatarsalgia in elastic deformities of the feet [dissertation abstract]. Moscow; 2020. 25 p. (In Russ).]
  20. Bignotti B, Signori A, Sormani MP, et al. Ultrasound versus magnetic resonance imaging for Morton neuroma: Systematic review and meta-analysis. Eur Radiol. 2015;25(8):2254–2262. doi: 10.1007/s00330-015-3633-3
  21. Lee MJ, Kim S, Huh YM, et al. Morton neuroma: Evaluated with ultrasonography and mr imaging. Korean J Radiol. 2007; 8(2):148–155. doi: 10.3348/kjr.2007.8.2.148
  22. Mak MS, Chowdhury R, Johnson R. Morton’s neuroma: Review of anatomy, pathomechanism, and imaging. Clin Radiol. 2021; 76(3):235.e15–235.e23. doi: 10.1016/j.crad.2020.10.006
  23. 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;54(4):549–553. doi: 10.1053/j.jfas.2014.09.021
  24. Torres-Claramunt R, Ginés A, Pidemunt G, et al. MRI and ultrasonography in Morton’s neuroma: Diagnostic accuracy and correlation. Indian J Orthop. 2012;46(3):321–325. doi: 10.4103/0019-5413.96390
  25. Raouf T, Rogero R, McDonald E, et al. Value of preoperative imaging and intraoperative histopathology in Morton’s neuroma. Foot Ankle Int. 2019;40(9):1032–1036. doi: 10.1177/1071100719851121
  26. Claassen L, Bock K, Ettinger M, et al. Role of MRI in detection of Morton’s neuroma. Foot Ankle Int. 2014;35(10):1002–1005. doi: 10.1177/1071100714540888
  27. Murphey MD, Smith WS, Smith SE, et al. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: Radiologic-Pathologic correlation. Radiographics. 1999;19(5): 1253–1280. doi: 10.1148/radiographics.19.5.g99se101253
  28. Dakkak YJ, Niemantsverdriet E, van der Helm-van Mil AH, Reijnierse M. Increased frequency of intermetatarsal and submetatarsal bursitis in early rheumatoid arthritis: A large case-controlled MRI study. Arthritis Res Ther. 2020;22(1):277. doi: 10.1186/s13075-020-02359-w
  29. DeHeer PA, Nanrhe AR, Michael ShR et al. Gender Correlation to the Prevalence of Pedal Neuromas in Various Interspaces — A Retrospective Study. J Am Podiatr Med Assoc. 2020;(18):089. doi: 10.7547/18-089
  30. Owens R, Gougoulias N, Guthrie H, Sakellariou A. Morton’s neuroma: Clinical testing and imaging in 76 feet, compared to a control group. Foot Ankle Surg. 2011;17(3):197–200. doi: 10.1016/j.fas.2010.07.002
  31. Di Caprio F, Meringolo R, Eddine MS, Ponziani L. Morton’s interdigital neuroma of the foot. Foot Ankle Surg. 2018;24(2): 92–98. doi: 10.1016/j.fas.2017.01.007
  32. LiMarzi GM, Scherer KF, Richardson ML, et al. CT and MR imaging of the postoperative ankle and foot. RadioGraphics. 2016;36(6):1828–1848. doi: 10.1148/rg.2016160016
  33. Terk MR, Kwong PK, Suthar M, et al. Morton neuroma: Evaluation with MR imaging performed with contrast enhancement and fat suppression. Radiology. 1993;189(1):239–241. doi: 10.1148/radiology.189.1.8372200

Supplementary files

Supplementary Files
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2. Fig. 1. Hypointensive and hyperintensive signal compared to muscles in T2 FS (fat suppression) images in the III interdigital space.

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3. Fig. 2. Hypointensive signal as compared to the muscles in T1 images directly in the area of the III interdigital space.

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4. Fig. 3. Histology: fibrosis of the interdigital nerve (а), thickness of the epineurium and fibrosis of the epineural blood vessels (б).

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