Abstract
Background: Morton’s Neuroma is most likely a mechanically induced degenerative neuropathy, presenting as forefoot pain.
Methods: The authors retrospectively reviewed clinical notes, imaging and histology from 71 consecutive patients (75 feet) treated operatively for Morton’s Neuroma between January 2006 and April 2009 and a control group of 20 patients (20 feet) undergoing MRI for other forefoot pathology. 7 feet were excluded from the surgical group due to recurrent disease or missing data.
Results: 84% of the surgical group were female. Mean age was 52. 97.4% of the surgical group presented with pain. 50% described pain in the plantar aspect of the forefoot and 85% reported that their pain was worse in shoes. Web space tenderness was positive in 95%, foot squeeze test 88%, plantar percussion 61% and toe tip sensation deficit 67%. Any two tests were positive in 92% of this group. In the control group any two tests were positive in only 39% – this difference was statistically significant (p< 0.0001 chi-squared test). MRI identified a neuroma in 97% of the surgical group (mean size 8mm) and 50% of the control group (mean size 6mm). 68% were in the 3rd web space; the remainder were in the 2nd web space. Histology confirmed neuroma in 99%.
Discussion: This cohort is larger than any other published series and is further strengthened by both the consistency of clinical testing and the independence of radiological and histological assessment.
Conclusion: We found that diagnosis of Morton’s neuroma was accurate. MRI correctly identified the neuromata in 97% and at least two clinical tests were present in 92%.
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
