Morton's neuroma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Mohsin, M.B.B.S.[2]

Overview

Morton's neuroma must be differentiated from other causes of pain in the forefoot such as metatarsophalangeal joint capsulitis, intermetatarsal bursitis, calluses, stress fractures, Freiberg's disease, osteomyelitis, localized vasculitis, ischemia of plantar digital artery, tarsal tunnel syndrome, rheumatoid arthritis, peripheral neuritis, synovitis, tendonitis, and avascular necrosis.

Differentiating Morton's Neuroma from other Diseases

Differentiating Morton's neuroma from other diseases
Disease/Condition Underlying Etiology Pathophysiology Clinical presentation Other associated features
Morton's neuroma

On gross pathology, characteristic findings of morton's neuroma, include:

Symptoms of morton's neuroma include:

Usually located at the following sites:

(first toe is usually not involved)

Metatarsophalangeal joint capsulitis/Metatarsalgia
Intermetatarsal bursitis _
Calluses Repeated contact, irritation, friction or grinding pressure to the skin caused by any of the following:
Metatarsal stress fracture[2] Repeated extraordinary stress, overuse, or trauma to the bone caused by any of the following: Stress fracture can be prevented by following measures:


Freiberg's disease Etiology is usually unknown or maybe multifactorial such as:


Vascular compromise leads to: Usually invovles the second or third metatarsal heads causing:
Osteomyelitis Common causes include:


Entry of the organism into bone is the first step in osteomyelitis and occurs by three main mechanisms:

  1. Hematogenous seeding
  2. Contiguous spread of infection to bone from adjacent soft tissue
  3. Direct inoculation from trauma or orthopedic surgery (including prostheses)
Risk factors for osteomyelitis include:
Localized vasculitis[3][4]
Tarsal tunnel syndrome (TTS) Anything that creates pressure in the Tarsal Tunnel can cause TTS such as:
Rheumatoid arthritis[5][6][7][8][9][10] Common causes include:

On gross pathology, following features may be noticed:

Microscopic histopathological analysis shows:

Common symptoms of rheumatoid arthritis include:

Conditions associated with rheumatoid arthritis include:

Patients with rheumatoid arthritis may have a positive history of:

Peripheral neuritis Symptoms depend on the nerve involved and may include: _
Synovitis It can be caused by any of the following: _
Tendonitis
Avascular necrosis[11] Permanent or temporary lack of blood supply to the bones due to:


Also known as:

Common sites of involvement in the order of frequency include:

References

  1. "intermetatarsal bursitis | The Foot and Ankle Online Journal".
  2. Kelsey JL, Bachrach LK, Procter-Gray E, Nieves J, Greendale GA, Sowers M; et al. (2007). "Risk factors for stress fracture among young female cross-country runners". Med Sci Sports Exerc. 39 (9): 1457–63. doi:10.1249/mss.0b013e318074e54b. PMID 17805074.
  3. Burke AP, Virmani R (2001). "Localized vasculitis". Semin Diagn Pathol. 18 (1): 59–66. PMID 11296994.
  4. Quinet RJ, Zakem JM, McCain M (2003). "Localized versus systemic vasculitis: diagnosis and management". Curr Rheumatol Rep. 5 (2): 93–9. PMID 12628039.
  5. Barton A, Worthington J (October 2009). "Genetic susceptibility to rheumatoid arthritis: an emerging picture". Arthritis Rheum. 61 (10): 1441–6. doi:10.1002/art.24672. PMID 19790122.
  6. Hitchon CA, Chandad F, Ferucci ED, Willemze A, Ioan-Facsinay A, van der Woude D, Markland J, Robinson D, Elias B, Newkirk M, Toes RM, Huizinga TW, El-Gabalawy HS (June 2010). "Antibodies to porphyromonas gingivalis are associated with anticitrullinated protein antibodies in patients with rheumatoid arthritis and their relatives". J. Rheumatol. 37 (6): 1105–12. doi:10.3899/jrheum.091323. PMID 20436074.
  7. Routsias JG, Goules JD, Goules A, Charalampakis G, Pikazis D (July 2011). "Autopathogenic correlation of periodontitis and rheumatoid arthritis". Rheumatology (Oxford). 50 (7): 1189–93. doi:10.1093/rheumatology/ker090. PMID 21343168.
  8. Barrett JH, Brennan P, Fiddler M, Silman AJ (June 1999). "Does rheumatoid arthritis remit during pregnancy and relapse postpartum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy". Arthritis Rheum. 42 (6): 1219–27. doi:10.1002/1529-0131(199906)42:6<1219::AID-ANR19>3.0.CO;2-G. PMID 10366115.
  9. Louati K, Berenbaum F (October 2015). "Fatigue in chronic inflammation - a link to pain pathways". Arthritis Res. Ther. 17: 254. doi:10.1186/s13075-015-0784-1. PMC 4593220. PMID 26435495.
  10. Nikolaus S, Bode C, Taal E, van de Laar MA (July 2013). "Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review". Arthritis Care Res (Hoboken). 65 (7): 1128–46. doi:10.1002/acr.21949. PMID 23335492.
  11. Enge Junior DJ, Fonseca EKUN, Castro ADAE, Baptista E, Santos DDCB, Rosemberg LA (2019). "Avascular necrosis: radiological findings and main sites of involvement - pictorial essay". Radiol Bras. 52 (3): 187–192. doi:10.1590/0100-3984.2017.0151. PMC 6561372 Check |pmc= value (help). PMID 31210694.

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