Difference between revisions of "Morton's neuroma differential diagnosis"

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(Differentiating Morton's Neuroma from other Diseases)
(Differentiating Morton's Neuroma from other Diseases)
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* Since a neuroma is a soft tissue condition, an [[MRI]] should be helpful in diagnosis, however, often an MRI will be inconclusive for neuroma even though a neuroma exists
 
* Since a neuroma is a soft tissue condition, an [[MRI]] should be helpful in diagnosis, however, often an MRI will be inconclusive for neuroma even though a neuroma exists
 
* Other conditions to consider are:
 
* Other conditions to consider are:
** Capsulitis:
+
** Capsulitis
*** Inflammation of ligaments that surrounds two bones, at the level of the joint
 
*** In this case it would be the ligaments that attach the toe bone to the metatarsal bone
 
*** Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma type symptoms
 
 
** Intermetatarsal [[bursitis]] between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve
 
** Intermetatarsal [[bursitis]] between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve
 
** Arthritis of joints that join the toes to the foot
 
** Arthritis of joints that join the toes to the foot
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** Stress fractures
 
** Stress fractures
 
** Freiberg's disease
 
** Freiberg's disease
 +
{| class="wikitable"
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|+Differentiating Morton's neuroma from other diseases
 +
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease/Condition}}
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! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Underlying Etiology}}
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Pathophysiology}}
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! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Clinical presentation}}
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! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Other associated features}}
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|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Morton's neuroma
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|
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* [[Improper rotation|Improper]] [[Foot|footwear]] or tight [[Shoe insert|shoes]] with tapered [[toe]] [[box]]
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* [[Abnormal]] [[Position effect|positioning]] of [[toes]]
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* [[Flat feet]]
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* Overpronation
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* High [[Arches of the foot|foot arches]]
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* High [[Heel|heels]]
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* [[Gait Abnormalities|Gait abnormalities]]
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* [[Foot|Forefoot]] [[Problem Solved|problems]] such as:
 +
** [[Bunion|Bunions]]
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** [[Hammer toe|Hammer toes]]
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* High-[[Impacted|impact]] [[Sports medicine|sports]] such as:
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** [[Rock climbing|Rock-climbing]]
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** Ballet dancing
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** Jogging
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** [[Running]]
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** [[Snow]] skiing
 +
** Racquet [[Sports medicine|sports]]
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** Court [[Sports medicine|sports]]
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|
 +
 +
On [[gross pathology]], [[Characteristic impedance|characteristic]] findings of [[morton's neuroma]], include:
 +
* Adherent fibrofatty [[Tissue (biology)|tissue]]
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* Small, [[Firming agent|firm]], [[oval]], [[Yellowing|yellowish]]-[[White (mutation)|white]], [[Slow|slowly]] [[Growth|growing]], [[palpable]] [[nodule]] on [[skin]] (no discoloration of [[skin]] on the [[Top note|top]] of [[nodule]])
 +
* </=2cm in [[Size consistency|size]] [[Size consistency|On]] [[microscopic]] [[histopathological]] [[analysis]], [[Characteristic impedance|characteristic]] findings of [[morton's neuroma]] include:
 +
** [[Size consistency|Extensive]] [[fibrosis]] around and within the [[nerve]]
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** [[Digit ratio|Digital]] [[artery]]
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** [[Thrombosis]]
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** [[Epineurium|Epineural]] and [[Endoneurium|endoneural]] [[arterial]] [[Thickener|thickening]]/[[vascular]] [[Hyaline|hyalinization]]
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** [[Degenerate|Degenerated]]/[[Demyelination|demyelinated]] [[axons]]
 +
|
 +
 +
[[Symptoms]] of [[morton's neuroma]] include:
 +
* [[Feeling]] like <nowiki>''</nowiki>[[walking]] on a marble<nowiki>''</nowiki> or a pebble in the [[Shoe insert|shoe]] or bunched-up sock
 +
* Most common [[symptom]] is [[pain]] in the [[Affect|affected]] [[area]] [[Causes|caused]] by [[pressure]] on the enlarged [[section]] of [[nerve]] where it [[Passing (sociology)|passes]] between the [[Metatarsal bones|metatarsal]] [[Head (anatomy)|heads]], and is squeezed between them
 +
* [[Pain]] is persistent & has the following [[Characteristic impedance|characteristics]]:
 +
** Occurs mostly on [[weight]] bearing while [[walking]] or [[Wear red day|wearing]] [[Shoe insert|shoes]] that squeeze the [[feet]]
 +
** Occurs [[Frequentism|frequently]] after only a [[Short time duty|short time]]
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** [[Affect|Affects]] the [[contiguous]] [[Half cell|halves]] of two [[toes]]
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** [[Pain]] tends to ease off at the night [[Time-series|time]]
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** [[Nature]] of [[pain]] maybe any of the following:
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*** [[Shooting, shoveling, and shutting up|Shooting]]
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*** [[Burn|Burning]]
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*** Stabbing
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*** [[Raw]]
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*** Gnawing
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*** [[Sick|Sickening]] [[sensations]]
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* [[Numbness]]
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* [[Parasthesia]]
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* [[Dysesthesia]] ([[painful]] [[hypersensitivity]] to normal [[light]] [[tactile]] [[Stimulants|stimuli]])
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* [[Function (biology)|Functional]] [[impairment]]
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* [[Psychological]] [[distress]] (severely decreasing the [[quality of life]])
 +
|Usually [[Location parameter|located]] at the following sites:
 +
* [[Third metatarsal bone|Third]] [[intermetatarsal]] space most commonly (between [[Third metatarsal bone|third]] and [[Fourth metatarsal bone|fourth metatarsals]])
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* [[Second metatarsal bone|Second]] or [[Fourth metatarsal bone|fourth]] [[Intermetatarsal|interspaces]]
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* At the [[bifurcation]] of the fourth [[plantar]] [[digital nerve]]
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* [[Fifth metatarsal|Fifth]] [[Intermetatarsal|interspace]] ([[Rare|rarely]])
 +
(first [[toe]] is usually not involved)
 +
|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Capsulitis
 +
|
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* '''Abnormal''' foot mechanics (putting excessive amount of weight bearing pressure on the ball of the foot beneath the toe joint)
 +
* Repetitive foot motion exerting pressure on the ball of foot resulting in connective tissue degeneration
 +
* Severe bunion deformity
 +
* Second toe longer than the big toe
 +
* Structurally unstable arch of the foot
 +
* Tight calf muscles
 +
|
 +
* Inflammation of ligaments that surrounds two bones, at the level of the joint (in this case, ligaments that attach the toe bone to the metatarsal bone)
 +
* Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma type symptoms
 +
|
 +
* Pain, particularly on the ball of the foot (feeling of a marble in the shoe or a bunched up sock)
 +
* Swelling at the base of the toe
 +
* Difficulty wearing shoes
 +
* Pain while walking barefoot
 +
* Crossover toe (end-stage of capsulitis)
 +
|
 +
|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Intermetatarsal [[bursitis]]
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|
 +
|
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* Between the third and fourth metatarsal bones will give neuroma type symptoms because it too puts pressure on the nerve
 +
|
 +
|
 +
|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Arthritis of metatarsophalangeal joints (join the toes to the foot)
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|
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|
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|
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|
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|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Calluses
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|
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|
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|
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|
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|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Stress fractures
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|
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|
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|
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|
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|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Freiberg's disease
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|
 +
|
 +
|
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|
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|}
  
 
==References==
 
==References==

Revision as of 01:37, 15 June 2019

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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 capsulitis, intermetatarsal bursitis, arthritis of intermetatarsal joints, calluses, stress fractures, and Freiberg's disease.

Differentiating Morton's Neuroma from other Diseases

  • Morton's neuroma must be differentiated from other causes of pain in the forefoot because too often all forefoot pain is categorized as neuroma
  • Since a neuroma is a soft tissue condition, an MRI should be helpful in diagnosis, however, often an MRI will be inconclusive for neuroma even though a neuroma exists
  • Other conditions to consider are:
    • Capsulitis
    • Intermetatarsal bursitis between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve
    • Arthritis of joints that join the toes to the foot
    • Calluses
    • Stress fractures
    • Freiberg's disease
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)

Capsulitis
  • Abnormal foot mechanics (putting excessive amount of weight bearing pressure on the ball of the foot beneath the toe joint)
  • Repetitive foot motion exerting pressure on the ball of foot resulting in connective tissue degeneration
  • Severe bunion deformity
  • Second toe longer than the big toe
  • Structurally unstable arch of the foot
  • Tight calf muscles
  • Inflammation of ligaments that surrounds two bones, at the level of the joint (in this case, ligaments that attach the toe bone to the metatarsal bone)
  • Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma type symptoms
  • Pain, particularly on the ball of the foot (feeling of a marble in the shoe or a bunched up sock)
  • Swelling at the base of the toe
  • Difficulty wearing shoes
  • Pain while walking barefoot
  • Crossover toe (end-stage of capsulitis)
Intermetatarsal bursitis
  • Between the third and fourth metatarsal bones will give neuroma type symptoms because it too puts pressure on the nerve
Arthritis of metatarsophalangeal joints (join the toes to the foot)
Calluses
Stress fractures
Freiberg's disease

References


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