Sonographic evaluation of interdigital neuromas

doi:10.1016/S1067-2516(97)80038-5

The Journal of Foot and Ankle Surgery

Volume 36, Issue 5, September–October 1997, Pages 364-366

https://doi.org/10.1016/S1067-2516(97)80038-5 Get rights and content

The purpose of this study is to evaluate the effectiveness of sonography to accurately identify interdigital neuromas. Twenty patients, all complaining of interdigital neuroma type pain, underwent sonographic evaluation of the symptomatic intermetatarsal space and adjacent interspaces. Each patient subsequently had surgical exploration of the symptomatic site. Fourteen patients had sonographic evidence of neuromas which were confirmed surgically; one patient had sonographic evidence of a neuroma that was not confirmed surgically. The remaining five patients did not have sonographic or surgical evidence of neuroma in spite of clinical signs and symptoms. No adjacent neuromas were appreciated. The correlation of sonography and clinical measurements was determined using Pearson's product moment correlation coefficient (r = 0.804, p < 0.001). Measurements performed with ultrasound were highly correlated with surgical findings. The mean size (standard deviation) of neuromas identified with ultrasound and during surgical inspection was 5.35 mm. (1.36) and 5.43 mm. (1.04). Ultrasound demonstrated a sensitivity of 100% and a specificity of 83.3%. Ultrasound was able to accurately predict the presence, size, and location of Morton's neuromas.

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Cited by (57)

Intermetatarsal ligament section assisted with sonography for the percutaneous surgery of Morton's disease: Cadaveric study
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Surgical treatment of Morton’s neuroma remains controversial. Several surgical techniques have been described including percutaneous transection of the deep metatarsal transverse ligament (DMTL).
To evaluate the efficacy and safety of percutaneous release of the DMTL under ultrasound guidance for the treatment of Morton’s syndrome.
Percutaneous release of the DMTL was performed with ultrasound guidance in 48 intermetatarsal spaces of 16 cadaveric specimens. Specimens were then dissected to assess the completion of the release and the presence of any injuries of the neurovascular and tendinous adjacent structures.
The DMTL was visualized with ultrasound in all cases. Complete release of the ligament was achieved in 87.5% (42/48) cases. One case of interdigital nerve injury was found.
Percutaneous release of DMTL with ultrasound guidance for the treatment of Morton’s disease has an acceptable rate of complications but care must be taken to ensure the complete release of the ligament.
Morton's neuroma: review of anatomy, pathomechanism, and imaging
2021, Clinical Radiology
Citation Excerpt :
Identification of the plantar digital nerve in continuity with the lesion improves specificity and diagnostic confidence (Fig. 3).22 The normal common plantar digital nerve measures approximately 1–2 mm in diameter,22,23 but the presence of nerve oedema is felt to improve its conspicuity.22 On ultrasound, a Morton's neuroma is usually not well differentiated from a coexisting intermetatarsal bursa.
Morton's neuroma is a commonly encountered cause of forefoot pain, which may limit weight-bearing activities and footwear choices. Although the aetiology and pathomechanism of this condition is controversial, the histological endpoint is well established as benign perineural fibrosis of a common plantar digital nerve, typically within the third intermetatarsal space. The diagnosis of Morton's neuroma is mainly based on characteristic symptoms and clinical findings, but may be confirmed by ultrasonography. Although ultrasound is a highly accurate diagnostic tool for Morton's neuroma, it is subject to interoperator variability due to differences in technique and level of experience. In this paper, the authors review the anatomy of the common plantar digital nerves and surrounding structures in the forefoot, which are deemed relevant to the understanding of Morton's neuroma, especially from a sonographic point of view. Several theories of the pathomechanism of Morton's neuroma are briefly discussed. The main purpose of this article is to illustrate the ultrasound techniques for evaluating Morton's neuroma and performing ultrasound-guided corticosteroid injections.
Sclerosing alcohol injections for the management of intermetatarsal neuromas: A systematic review
2018, Foot
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.
Clinical Utility of High-Frequency Musculoskeletal Ultrasonography in Foot and Ankle Pathology: How Ultrasound Imaging Influences Diagnosis and Management
2017, Journal of Foot and Ankle Surgery
Citation Excerpt :
Furthermore, ultrasonography is useful in the detection of Morton neuroma. Sobiesk et al (21) reported 95% detection accuracy for Morton neuroma with ultrasonography, and other studies (22,23) have shown that ultrasonography can detect smaller Morton neuromas than MRI. Only a few studies have addressed the effect of ultrasonography on the diagnosis and management for a heterogeneous group of patients; these have mainly appeared in rheumatology studies.
The use of high-frequency (high-resolution) musculoskeletal ultrasonography is increasing and has shown promising utility in many areas of medicine. The utility of musculoskeletal ultrasonography for foot and ankle complaints has not been widely investigated, however. Although some conditions of the foot and ankle are easily diagnosed by physical examination, others can have nonspecific examination findings, making optimal treatment decisions difficult. We hypothesized that high-resolution musculoskeletal ultrasound scanning of the foot and ankle can affect the diagnosis and/or treatment for patients presenting with foot or ankle complaints. Retrospectively, the cases of 98 patients who had undergone musculoskeletal ultrasound scanning of the foot or ankle were reviewed. The pre-ultrasound clinical diagnosis and treatment were compared with the post-ultrasound diagnosis and treatment. In 64% of the patients, the diagnosis or treatment changed after the ultrasound examination. In 43% of patients, both the diagnosis and the treatment changed after ultrasound scanning. For those patients for whom the diagnosis and treatment were unchanged after the ultrasound examination, the ultrasound findings were concordant with the pre-ultrasound clinical diagnosis for 100% of the patients. These results suggest that in a large proportion of patients, high-resolution musculoskeletal ultrasonography of the foot or ankle can facilitate appropriate diagnosis and management.
Ultrasound-Guided Peripheral Nerve Procedures
2016, Physical Medicine and Rehabilitation Clinics of North America
Citation Excerpt :
They lie inferior to the intermetatarsal ligament at the level of the metatarsal heads. Ultrasound has good accuracy for identification and measurement of interdigital neuromas.106–108 The transducer is scanned over the distal metatarsal region, usually in short-axis at first, but is also compared in long-axis (Fig. 35).
Diagnostic Value of Elastography in the Diagnosis of Intermetatarsal Neuroma
2016, Journal of Foot and Ankle Surgery
Citation Excerpt :
US sensitivity has been reported to be 56.5% to 100% in published studies (4,7,29,32–35). Likewise, the mean size of interdigital neuromas has been reported to vary from 4.9 to 7.4 mm (3,4,11,33,35,36). Neuromas >5 mm in size are more likely to cause symptoms (9,28,33,37).
The objective of the present study was to characterize the ultrasound and elastographic properties of intermetatarsal neuroma (interdigital neuroma) and their contribution to diagnosis. Eighteen patients with metatarsalgia, who had presented to an orthopedic clinic from April 2013 to February 2015, were diagnosed with 25 intermetatarsal neuromas (11 unilateral [61.11%], 7 bilateral [38.89%]). These patients underwent evaluation with ultrasonography and simultaneous ultrasound strain elastography to assess the elastographic properties of the tissues in the intermetatarsal space. The intermetatarsal neuroma diagnosis was confirmed by histopathologic inspection. The lesion contours, localization, dimensions, and vascularization were evaluated before surgical excision. The elasticity and strain ratio values were compared between the neuroma and adjacent healthy intermetatarsal space. Of the 25 intermetatarsal neuromas, 1 (4%) was not detected by ultrasonography (incidence of detection of 96%). The mean neuroma width was 6.35 (range 3.7 to 13) mm in the coronal plane, and the mean elasticity and strain ratio values were 3.44 (range 1.1 to 5.1) and 9.47 (range 2.3 to 19.3), respectively. The elasticity and strain ratio values were significantly greater in the presence of an interdigital neuroma than in the adjacent healthy intermetatarsal spaces (Z = −3.964, p = .0001 and Z = −3.927, p = .0001, respectively). The diagnostic cutoff values were calculated as 2.52 for elasticity and 6.1 for the strain ratio. Four neuromas (16%) were not demarcated, and the elasticity and strain ratio values for these were lower than those for neuromas with demarcated contours but were greater than those for healthy intermetatarsal spaces (p < .006 and p < .005, respectively). Patients with clinically suspected intermetatarsal neuromas that do not show demarcation and with smaller lesions might benefit from the use of ultrasound elastography for diagnosis.

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⁴: From St. John Hospital-Macomb Center, 26755 Ballard Rd., Harrison Twp., MI.

¹: Submitted while third year resident.

²: Director of Podiatric Medical Education; Diplomate, American Board of Podiatric Surgery.

³: Department of Radiology, St. John Hospital, Detroit, MI.

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Sonographic evaluation of interdigital neuromas

Radiol. Clin. North Am.

A peculiar and painful affection of the fourth metatarsalphalangeal articulation

Am. J. Med. Sci.

Persistent pain after excision of an Interdigital neuroma

J. Bone Joint Surg.

Interdigital neuroma—a critical clinical analysis

Foot Ankle

Gadopentetate enhancement magnetic resonance imaging with fat saturation in the evaluation of Morton's neuroma

J. Foot Surg.

Electron microscopic analysis of interdigital neuroma

Clin. Orthop.

Morton's toe

Clin. Orthop.

Morton neuroma: monographic evaluation

Radiology