Prevalence of Asymptomatic Interdigital Nerve Enlargements

NewsBot · Jun 28, 2012

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Prevalence of Interdigital Nerve Enlargements in an Asymptomatic Population
Panagiotis D. Symeonidis; Lukas D. Iselin; Neil Simmons
Foot & Ankle International; July 2012 (Vol. 33 #7) July 1, 2012

Morton’s neuroma is a common primary diagnosis for referral to foot and
ankle surgeons. On presentation, many patients have had an ultrasound
reporting the presence of Morton’s neuroma, which may not correlate
with the clinical examination findings. The prevalence of such
sonographic findings in the general population remains unknown.

Methods: In this observational prospective study, patients with
asymptomatic forefeet who were seen by two foot and ankle surgeons for
unrelated mid- or hind foot pathology were examined clinically and
sonographically for the presence of interdigital nerve thickening.
Forty-eight volunteers participated in the study (96 feet). For the
purpose of this study, asymptomatic thickenings greater than 5 mm in
diameter were termed sonographic neuromas. Ultrasound examination was
performed by two specialist musculoskeletal radiologists.

Results:
Fifty-four percent of the volunteers (26 of 48) had sonographic nerve
thickening and in 17 cases (35.4%) enlarged nerves were found
bilaterally. Differences for gender, original diagnosis or side of
original pathology were not significant. Older subjects were more
likely to have a sonographic neuroma (p = 0.018). Feet with a positive
Mulder’s click were more likely to have a sonographic neuroma (p =
0.015).

Conclusion: Ultrasound, even in highly skilled hands, has a
high rate of incidental finding of an asymptomatic interdigital nerve
enlargement, which can lead to a false diagnosis of a Morton’s neuroma.
Sonographic evidence of Morton’s neuroma per se is unreliable unless it
is correlated with an equivocal clinical examination. Clinical
examination is still the gold standard for the diagnosis of a Morton’s
neuroma.
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W J Liggins · Jun 28, 2012

Hmmmm slightly puzzling. First define a 'Morton's neuroma', second confirm what is a Mulder's sign and even if it exists, does it have any significance, and finally, as far as I am concerned, there is very little enlargement of the digital nerves in a symptomatic condition. The nerve hypertrophy in all the patients that I have seen, is intermetatarsal head.

All seems a little woolly.

Bill

Admin2 · Jun 28, 2012

Related threads:
Other threads tagged with mortons neuroma

NewsBot · Aug 13, 2014

Multiple Interdigital Neuromas: A Retrospective Study of 279 Feet with 462 Neuromas
José Valero, PhD, José Gallart, PhD, David González, PhD candidate, Javier Deus, MD, PhD, Manuel Lahoz, PhD, MD
The Journal of Foot and Ankle Surgery; Articles in Press

Morton's neuroma is a common pathologic entity that, traditionally, was considered to be an isolated tumor that rarely affected more than 1 interdigital space. However, in recent years, multiple neuromas have become more common in our day-to-day practice. The objective of the present study was to assess the frequency with which Morton's neuroma appears in the different interdigital spaces. A retrospective study was performed of 279 feet that had been surgically treated for Morton's neuroma using a dorsal approach during a 9-year period (from January 2003 to December 2011), with an ultrasound scan taken preoperatively and histopathologic analysis performed afterward. From the 279 treated feet, 462 interdigital neuromas were surgically removed. Of the 279 feet, 97 (34.8%) displayed isolated neuromas, and 182 (65.2%) were treated for multiple neuromas. Regarding the neuromas that were treated as isolated lesions, 74.2% were located in the third space. For the feet affected by multiple interdigital neuromas, 100% had a neuroma in the third space and 98.9% in the second. The incidence of multiple interdigital neuromas can be considered frequent. The assessment, therefore, of interdigital neuromas of the foot should include, at a minimum, the second and third interdigital spaces.
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