Purpose: To describe sonographic evaluation of Morton’s neuroma and to demonstrate the advantage of the ultrasound technique.

Material and methods: Between the years 1999–2001, eight patients were operated upon because of Morton’s neuroma in the 3rd interspace, using dorsal approach at the Basel Height Medical Center. Five patients were female and three were male, mean age 35 years (range, 17–51 years). All the patients suffered from metatarsalgia at the 3rd web while walking with shoes. No pain was noted when they walked barefoot. All the patients underwent sonographic evaluation by using high frequency transducers of 10 and 12 MHz. Plantar and dorsal scanning was performed with and without digital pressure of the metatarsal space.

Results: In all the operated cases ultrasound examination prior to surgery revealed an ovoid, well defined hypoecogenic mass of a mean diameter of 8 mm (range 7–15 mm), located in the third interdigital space, proximal to the metatarsal heads. Plantar scanning and dorsal digital pressure, by the examiner, disclosed the best sonographic images. All cases were confirmed by histological examination. No surgical complications were noted.

Conclusion: We present the sonographic appearance of Morton’s neuroma in eight cases that underwent surgical excision of the neuromas. We describe manual maneuvers in order to bring up the best images of the mass.

In vitamin D-fed chicks 1,25-dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 were implanted into experimentally-produced fractures of the mid-tibia. The mechanical and biochemical properties of the tibia were evaluated for two weeks, including torsion tests, measurement of alkaline phosphatase activity, 45Ca incorporation, and Ca2+ content. Both dihydroxylated metabolites of vitamin D3 had a direct effect on endochondral bone formation. 24,25(OH)2D3 strengthened the callus, and raised alkaline phosphate activity in the first seven days after fracture. 1,25(OH)2D3 decreased the strength of the callus concomitant with a reduction in 45Ca incorporation. It is suggested that local application of 24,25(OH)2D3 into fractures may accelerate healing and prevent non-union.

The levels of the active metabolites of vitamin D were measured in the callus and in the epiphyseal growth plate of chicks given radioactive cholecalciferol during fracture healing. Those levels were correlated with the histological findings. Three groups of chicks were studied: a control group with no fracture, chicks with fractures fixed by Kirschner wire, and chicks with unfixed fractures. A significant increase in the levels of the active metabolites was found in the callus during the first few days after fracture. The levels of 25-hydroxycholecalciferol [25(OH)D3] and of 24,25-dihydroxycholecalciferol [24,25(OH)2D3] were higher when there was no fixation, while those of 1,25-dihydroxycholecalciferol [1,25(OH)2D3] were higher after fixation. The concentrations of these metabolites in the proximal epiphysis of the tibia were similar to those found in the callus. Based on these findings it is suggested that the active metabolites of vitamin D are directly involved in the process of fracture repair.