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Interdigital Nerve Entrapment

  • Beth S. PearceEmail author
  • Michael N. Brown
  • Thais Khouri Vanetti

Abstract

Interdigital neuritis is a painful entrapment syndrome of the forefoot commonly named “Morton’s neuroma” and most often described by pain and radiating numbness to the toes. The pathology is more correctly understood as a compression of the common digital nerve. It is most frequently found within the third intermetatarsal space and is often related to women who have worn high heels for many years. This pain condition may be treated with nerve block or with neurolytic or surgical techniques.

Keywords

Interdigital neuritis Neuroma Foot pain Morton’s neuroma 

Supplementary material

Video 70.1

Physical examination of the digital nerve (MOV 22400 kb)

Video 70.2

Landmark-guided injection of the digital nerve (MOV 28259 kb)

References

  1. 1.
    McCrory P, Bell S, Bradshaw C. Nerve entrapments of the lower leg, ankle and foot in sport. Sports Med. 2002;32(6):371–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Morton T. A peculiar and painful affection of the fourth metatarsophalangeal articulation. Am J Med Sci. 1876;71:37–45.CrossRefGoogle Scholar
  3. 3.
    Durlacher L. Treatise on corns, bunions, diseases of nails, and the general management of the feet. London: Simpkin and Marshall; 1845. p. 52.Google Scholar
  4. 4.
    Franson J, Baravarian B. Intermetatarsal compression neuritis. Clin Podiatr Med Surg. 2006;23(3):569–78.CrossRefPubMedGoogle Scholar
  5. 5.
    Viladot A. Morton’s neuroma. Int Orthop. 1992;3:294–6.Google Scholar
  6. 6.
    Thomas J, Blitch E, Chaney D, Dinucci K, Eickmeier K, Rubin L, et al. Diagnosis and treatment of forefoot disorders. Section 3. Morton’s intermetatarsal neuroma. J Foot Ankle Surg. 2009;48(2):251–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Kim J, Choi J, Park J, Wang J, Lee I. An anatomical study of Morton’s interdigital neuroma: the relationship between the occurring site and the DTML. FAI. 2007;28(9):1007–10.Google Scholar
  8. 8.
    Schon LC, Baxter DE. Neuropathies of the foot and ankle in athletes. Clin Sports Med. 1990;9(2):489–509.PubMedGoogle Scholar
  9. 9.
    Prisk VR, O’Loughlin PF, Kennedy JG. Forefoot injuries in dancers. Clin Sports Med. 2008;27(2):305–20.CrossRefPubMedGoogle Scholar
  10. 10.
    Dockery GL. The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections. J Foot Ankle Surg. 1999;38(6):403–8.CrossRefPubMedGoogle Scholar
  11. 11.
    de Asla R, Deland J. Foot and ankle. 2nd ed. In: Thordarson DB, Tornetta P, Einhorn TA, editors. Orthopaedic Surgery Essentials: Foot and Ankle. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004. p. 18–23.Google Scholar
  12. 12.
    Zanetti M, Strehle J, Kundert H, Zollinger H, Hodler J. Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions. Radiology. 1999;213(2):583–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Ghosh SK, Raheja S, Tuli A. Potential sites of compression of tibial nerve branches in foot: a cadaveric and imaging study. Clin Anat. 2013;26(6):768–79.CrossRefPubMedGoogle Scholar
  14. 14.
    Sullivan J. Neuroma diagnosis by means X-ray evaluation. J Foot Ankle Surg. 1967;6:45–6.Google Scholar
  15. 15.
    Mulder J. The causative mechanism in morton’s metatarsalgia. J Bone Joint Surg (Br). 1951;33:94–5.Google Scholar
  16. 16.
    Cloke D, Greiss M. The digital nerve stretch test: a sensitive indicator of Morton’s neuroma and neuritis. Foot Ankle Surg. 2006;12(4):201–3.CrossRefGoogle Scholar
  17. 17.
    Hassouna H, Singh D. Morton’s metatarsalgia: pathogenesis, aetiology and current management. Acta Orthop Belg. 2005;71:646–55.PubMedGoogle Scholar
  18. 18.
    Park H, Kim S, Rho M, Hong H, Lee S. Sonographic appearances of Morton’s neuroma: differences from other interdigital soft tissue masses. Ultrasound Med Biol. 2011;37(8):1209. 1/2/04.CrossRefGoogle Scholar
  19. 19.
    Zanetti M, Weishaupt D. MR imaging of the forefoot: morton neuroma and differential diagnoses. Semin Musculoskelet Radiol. 2005;9:175–86.CrossRefPubMedGoogle Scholar
  20. 20.
    Hofbauer P. Rheumatoid nodule in Morton’s neuroma. A case report. J Am Podiatry Assoc. 1974;64(6):424–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Iagnocco A, Coari G, Palombi G, Valesini G. Sonography in the study of metatarsalgia. J Rheumatol. 2001;28:1338–40.PubMedGoogle Scholar
  22. 22.
    Alexander I, Johnson K, Parr J. Morton’s neuroma: a review of recent concepts. Orthopedics. 1987;10:103–6.PubMedGoogle Scholar
  23. 23.
    Kaminsky S, Griffin L, Milsap J, Page D. Is ultrasonography a reliable way to confirm the diagnosis of Morton’s neuroma? Orthopedics. 1997;20:37–9.PubMedGoogle Scholar
  24. 24.
    Beggs I. Sonographic appearances of nerve tumors. J Clin Ultrasound. 1999;27:363–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Pollak R, Bellacosa R, Dornbluth N, Strash W, Devall J. Sonographic analysis of Morton’s neuroma. J Foot Surg. 1992;31:534–7.PubMedGoogle Scholar
  26. 26.
    Kankanala G, Jain A. The operational characteristics of ultrasonography for the diagnosis of plantar intermetatarsal neuroma. J Foot Ankle Surg. 2007;46:213–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Redd R, Peters V, Emery S, Branch H, Rifkin M. Morton neuroma: sonographic evaluation. Radiology. 1989;171:415–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Mendicino SS, Rockett MS. Morton’s neuroma: update on diagnosis and imaging. Clin Podiatr Med Surg. 1997;14:303–11.PubMedGoogle Scholar
  29. 29.
    DiGiovani C, Kuo R, Tejwani N, et al. Isolated gastrocnemius tightness. J Bone Joint Surg. 2002;84A:962–71.CrossRefGoogle Scholar
  30. 30.
    Rasmussen M, Kitaoka H, Patzer G. Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clin Orthop Relat Res. 1996;326:188–93.CrossRefGoogle Scholar
  31. 31.
    Greenfield J, Rea JJ, Ilfeld S. Morton’s interdigital neuroma: indications for treatment by local injections versus surgery. Clin Orthop Relat Res. 1984;185:142–4.Google Scholar
  32. 32.
    Hassouna H, Singh D, Taylor H, Johnson S. Ultrasound guided steroid injection in the treatment of interdigital neuralgia. Acta Orthop Belg. 2007;73(2):224–9.PubMedGoogle Scholar
  33. 33.
    Trescot AM. Cryoanalgesia in interventional pain management. Pain Phys. 2003;6(3):345–60.Google Scholar
  34. 34.
    Hughes R, Ali K, Jones H, Kendall S, Connell D. Treatment of Morton’s neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. Am J Roentgenol. 2007;188(6):1535–9.CrossRefGoogle Scholar
  35. 35.
    Steinberg M. The use of vitamin B-12 in Morton’s neuralgia. J Am Podiatr Med Assoc. 1955;45:566–7.Google Scholar
  36. 36.
    Magnan B, Marangon A, Frigo A, Bartolozzi P. Local phenol injection in the treatment of interdigital neuritis of the foot (Morton’s neuroma). Chir Organi Mov. 2005;90:371–7.PubMedGoogle Scholar
  37. 37.
    Noback CR. Podiatric treatment of Morton’s neuroma with cryoneurolytic technique. Jacksonv Med J. 2002;3(2):10–2.Google Scholar
  38. 38.
    Caporusso E, Fallat L, Savoy-Moore R. Cryogenic neuroablation for the treatment of lower extremity neuromas. J Foot Ankle Surg. 2002;41:286–90.CrossRefPubMedGoogle Scholar
  39. 39.
    Hodor L, Barkal K, Hatch-Fox L. Cryogenic denervation of the intermetatarsal space neuroma. J Foot Ankle Surg. 1997;36(4):311–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Vito G, Talarico L. A modified technique for Morton’s neuroma. Decompression with relocation. J Am Podiatr Med Assoc. 2003;93:190–4.CrossRefPubMedGoogle Scholar
  41. 41.
    Colgrove R, Huang E, Barth A, Greene M. Interdigital neuroma: intermuscular neuroma transposition compared with resection. Foot Ankle Int. 2000;21:206–11.CrossRefPubMedGoogle Scholar
  42. 42.
    Wu K. Morton’s interdigital neuroma: a clinical review of its etiology, treatment, and results. J Foot Ankle Surg. 1996;35:112–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Long-term evaluation of interdigital neuroma treated by surgical excision. Foot Ankle Int. 2008;29:574–7.CrossRefPubMedGoogle Scholar
  44. 44.
    Barrett SL, Rabat E, Buitrago M, Rascon VP, Applegate D. Endoscopic decompression of intermetatarsal nerve (EDIN) for the treatment of Morton’s entrapment—multicenter retrospective review. Open J Orthop. 2012;2:19–24.CrossRefGoogle Scholar
  45. 45.
    Walker E, Wright G, Burnett C. Alcohol neurolysis of digital nerves: is it safe? Texas Pain Foundation 7th Annual Scientific Meeting. San Antonio; 2015.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Beth S. Pearce
    • 1
    Email author
  • Michael N. Brown
    • 2
  • Thais Khouri Vanetti
    • 3
    • 4
  1. 1.Flagler Hospital (St. Augustine FL)Saint AugustineUSA
  2. 2.Interventional Regenerative Orthopedic Medicine InstituteSeattleUSA
  3. 3.Singular – Centro de Controle da DorCampinasBrazil
  4. 4.Instituto do Câncer do Estado de São PauloCampinasBrazil

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