Neuroma: Difference between revisions

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{{SI}}                                                                 
{{Neuroma}}                                                                 
{{CMG}}; {{AE}}{{S.M.}} {{MV}}
{{CMG}}; {{AE}} {{S.M.}}, {{MV}}
   
   
{{SK}} Traumatic neuroma; Morton neuroma; Amputation neuroma; Pseudoneuroma; Morton’s metatarsalgia; Plantar interdigital neuroma; Morton's intermetatarsal neuroma; Morton's entrapment; Morton's disease; Morton's neuropathy; Morton's neuralgia; Intermetatarsal neuroma; Intermetatarsal space neuroma; Intermetatarsal nerve entrapment; Interdigital neuroma; Interdigital nerve compression; Interdigital nerve enlargement; Joplin's neuroma; Plantar neuroma; Scar neuroma
{{SK}} Traumatic neuroma; Morton neuroma; Amputation neuroma; Pseudoneuroma; Morton’s metatarsalgia; Plantar interdigital neuroma; Morton's intermetatarsal neuroma; Morton's entrapment; Morton's disease; Morton's neuropathy; Morton's neuralgia; Intermetatarsal neuroma; Intermetatarsal space neuroma; Intermetatarsal nerve entrapment; Interdigital neuroma; Interdigital nerve compression; Interdigital nerve enlargement; Joplin's neuroma; Plantar neuroma; Scar neuroma; Terminal neuroma; Stump neuroma
   
   
==Overview==
==Overview==


'''Neuroma''' (''Neuro-'' is from the Greek for ''nerve'') is defined as a [[benign tumor]] of a [[nerve]]. However, neuroma commonly refers to any [[tumor]] of cells of the [[nervous system]]. Neuromas form part of the [[peripheral nerve]] sheath tumors and belong to Reactive class of tumors.  Neuroma was first described by Thomas Morton in 1876. Neuromas may be classified according to histopathological features into 3 groups: Morton's neuroma, traumatic neuroma, and neoplasic neuromas. The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular [[hyaline|hyalinization]], and perineural fibrosis. Neuroma is more commonly observed among patients aged between 15 to 50 years old. Neuroma is more commonly observed among middle aged adults. Females are more commonly affected with neuroma than males. The female to male ratio is approximately 5:1. Common risk factors in the development of neuroma include improper footwear and high impact sports (e.g., rock-climbing, ballet dancing). A major complication of neuroma is chronic neuropathic pain. On ultrasound, neuroma is characterized as a well-defined, hypoechoic lesion located in the intermetatarsal space proximal to the metatarsal head. Patients with neuroma usually appear with antalgic posture. Physical examination may be remarkable for tenderness to palpation and dysesthetic pain. Surgical excision is the treatment of choice for patients with neuroma; this surgical intervention is associated with a relatively favorable success rate, approximately 80%. The recurrence rate after surgery is as high as 50%.
Neuroma (''[[NeuroArm|Neuro]]-'' is from the [[Greek key|Greek]] for ''[[nerve]]'') is defined as a [[benign tumor]] of a [[nerve]]. However, neuroma commonly [[Reference|refers]] to any [[tumor]] of [[Cells (biology)|cells]] of the [[nervous system]]. Neuromas [[Formal charge|form]] part of the [[peripheral nerve]] sheath [[tumors]] and belong to [[Reaction|Reactive]] [[Class (biology)|class]] of [[tumors]].  Neuroma was first described by Thomas Morton in 1876. Neuromas may be [[Classification|classified]] according to [[histopathological]] [[Features (pattern recognition)|features]] into 3 [[Group (periodic table)|groups]]: [[Morton's neuroma]], [[Trauma|traumatic]] neuroma, and [[Neoplasic diseases|neoplasic]] neuromas. The [[pathogenesis]] of neuroma is [[Characterization (mathematics)|characterized]] by [[neural]] [[degeneration]] with [[Epineurium|epineural]] and [[Endoneurium|endoneural]] [[vascular]] [[hyaline|hyalinization]], and [[Perineurium|perineural]] [[fibrosis]]. Neuroma is more commonly [[Observation|observed]] among [[patients]] [[Age|aged]] between 15 to 50 [[Year|years]] old. Neuroma is more commonly [[Observation|observed]] among [[Middle age|middle aged]] [[Adult|adults]]. [[Females]] are more commonly [[Affect|affected]] with neuroma than [[males]]. The [[female]] to [[male]] [[ratio]] is approximately 5:1. Common [[risk factors]] in the [[development]] of neuroma include [[Improper rotation|improper]] footwear and high impact [[Sports medicine|sports]] (e.g., [[Rock climbing|rock-climbing]], ballet [[Dance therapy|dancing]]). A major [[Complications|complication]] of neuroma is [[chronic]] [[neuropathic pain]]. On [[ultrasound]], neuroma is [[Characterization (mathematics)|characterized]] as a well-defined, hypoechoic [[lesion]] [[Location parameter|located]] in the intermetatarsal space proximal to the metatarsal head. [[Patients]] with neuroma usually [[Appearance|appear]] with antalgic [[posture]]. [[Physical examination]] may be remarkable for [[tenderness]] to [[palpation]] and [[Dysesthesia|dysesthetic]] [[pain]]. [[Surgery|Surgical]] [[excision]] is the [[Treatments|treatment]] of [[Choice PT|choice]] for [[patients]] with neuroma; this [[Surgery|surgical]] [[Intervention (counseling)|intervention]] is [[Association (statistics)|associated]] with a relatively favorable success rate, approximately 80%. The [[Recurrence plot|recurrence rate]] after [[surgery]] is as high as 50%.


==Historical Perspective==
==Historical Perspective==
*The term neuroma originates from the following two Greek words:
*The [[Term logic|term]] neuroma originates from the following two [[Greek key|Greek]] words:
**''neuro-'' from the Greek word for ''nerve'' (νεῦρον)
**''[[NeuroArm|neuro]]-'' from the [[Greek key|Greek]] word for ''[[nerve]]'' (νεῦρον)
**''-oma'' (-ωμα) from the Greek word for ''swelling''
**''-oma'' (-ωμα) from the [[Greek key|Greek]] word for ''[[swelling]]''
*In 1876, Neuroma was first described by Thomas Morton
*In 1876, Neuroma was first described by Thomas [[Morton's neuroma|Morton]]


==Classification==
==Classification==
*Neuroma  may be classified according to histopathological features into following groups:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="Dorlands">{{cite encyclopedia|editor= |encyclopedia=Dorland's Illustrated Medical Dictionary| edition=32nd| title=Neuroma | url=http://books.google.com/books?id=mNACisYwbZoC&pg=PT5287|accessdate=25 August 2013| year=2011| publisher=Oxford University Press| isbn=978-1-4557-0985-4 |page=5287}}</ref><ref name="pmid25128316">{{cite journal| author=Valero J, Gallart J, González D, Deus J, Lahoz M| title=Multiple interdigital neuromas: a retrospective study of 279 feet with 462 neuromas. | journal=J Foot Ankle Surg | year= 2015 | volume= 54 | issue= 3 | pages= 320-2 | pmid=25128316 | doi=10.1053/j.jfas.2014.05.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25128316  }} </ref><ref name="pmid15177321">{{cite journal| author=Golan JD, Jacques L| title=Nonneoplastic peripheral nerve tumors. | journal=Neurosurg Clin N Am | year= 2004 | volume= 15 | issue= 2 | pages= 223-30 | pmid=15177321 | doi=10.1016/j.nec.2004.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15177321  }} </ref>
*Neuroma  may be [[Classification|classified]] according to [[histopathological]] [[Features (pattern recognition)|features]] into following [[Group (periodic table)|groups]]:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="Dorlands">{{cite encyclopedia|editor= |encyclopedia=Dorland's Illustrated Medical Dictionary| edition=32nd| title=Neuroma | url=http://books.google.com/books?id=mNACisYwbZoC&pg=PT5287|accessdate=25 August 2013| year=2011| publisher=Oxford University Press| isbn=978-1-4557-0985-4 |page=5287}}</ref><ref name="pmid25128316">{{cite journal| author=Valero J, Gallart J, González D, Deus J, Lahoz M| title=Multiple interdigital neuromas: a retrospective study of 279 feet with 462 neuromas. | journal=J Foot Ankle Surg | year= 2015 | volume= 54 | issue= 3 | pages= 320-2 | pmid=25128316 | doi=10.1053/j.jfas.2014.05.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25128316  }} </ref><ref name="pmid15177321">{{cite journal| author=Golan JD, Jacques L| title=Nonneoplastic peripheral nerve tumors. | journal=Neurosurg Clin N Am | year= 2004 | volume= 15 | issue= 2 | pages= 223-30 | pmid=15177321 | doi=10.1016/j.nec.2004.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15177321  }} </ref>
{| class="wikitable"
{| class="wikitable"
|+Classification of neuroma
|+Classification of neuroma
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! style="background:#4479BA; color: #FFFFFF;" align="center" + | Neoplastic nature
! style="background:#4479BA; color: #FFFFFF;" align="center" + | Neoplastic nature
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Morton neuroma'''<ref name="pmid17880876">{{cite journal| author=Kim JY, Choi JH, Park J, Wang J, Lee I| title=An anatomical study of Morton's interdigital neuroma: the relationship between the occurring site and the deep transverse metatarsal ligament (DTML). | journal=Foot Ankle Int | year= 2007 | volume= 28 | issue= 9 | pages= 1007-10 | pmid=17880876 | doi=10.3113/FAI.2007.1007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17880876  }} </ref><ref name="pmid10195292">{{cite journal| author=Read JW, Noakes JB, Kerr D, Crichton KJ, Slater HK, Bonar F| title=Morton's metatarsalgia: sonographic findings and correlated histopathology. | journal=Foot Ankle Int | year= 1999 | volume= 20 | issue= 3 | pages= 153-61 | pmid=10195292 | doi=10.1177/107110079902000303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10195292  }} </ref><ref name="pmid10954445">{{cite journal| author=Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E| title=Morton's neuroma: is it always symptomatic? | journal=AJR Am J Roentgenol | year= 2000 | volume= 175 | issue= 3 | pages= 649-53 | pmid=10954445 | doi=10.2214/ajr.175.3.1750649 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10954445  }} </ref><ref name="pmid7516653">{{cite journal| author=Bourke G, Owen J, Machet D| title=Histological comparison of the third interdigital nerve in patients with Morton's metatarsalgia and control patients. | journal=Aust N Z J Surg | year= 1994 | volume= 64 | issue= 6 | pages= 421-4 | pmid=7516653 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7516653  }} </ref><ref name="pmid8722878">{{cite journal| author=Wu KK| title=Morton's interdigital neuroma: a clinical review of its etiology, treatment, and results. | journal=J Foot Ankle Surg | year= 1996 | volume= 35 | issue= 2 | pages= 112-9; discussion 187-8 | pmid=8722878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8722878  }} </ref><ref name="pmid31040508">{{cite journal| author=Post MD| title=Mechanical Diagnosis and Therapy and Morton's Neuroma: A Case Report. | journal=Physiother Can | year= 2019 | volume= 71 | issue= 2 | pages= 130-133 | pmid=31040508 | doi=10.3138/ptc.2018-42 | pmc=6484954 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31040508  }} </ref>
| style="background:#DCDCDC;" align="center" + |'''[[Morton's neuroma]]'''<ref name="pmid17880876">{{cite journal| author=Kim JY, Choi JH, Park J, Wang J, Lee I| title=An anatomical study of Morton's interdigital neuroma: the relationship between the occurring site and the deep transverse metatarsal ligament (DTML). | journal=Foot Ankle Int | year= 2007 | volume= 28 | issue= 9 | pages= 1007-10 | pmid=17880876 | doi=10.3113/FAI.2007.1007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17880876  }} </ref><ref name="pmid10195292">{{cite journal| author=Read JW, Noakes JB, Kerr D, Crichton KJ, Slater HK, Bonar F| title=Morton's metatarsalgia: sonographic findings and correlated histopathology. | journal=Foot Ankle Int | year= 1999 | volume= 20 | issue= 3 | pages= 153-61 | pmid=10195292 | doi=10.1177/107110079902000303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10195292  }} </ref><ref name="pmid10954445">{{cite journal| author=Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E| title=Morton's neuroma: is it always symptomatic? | journal=AJR Am J Roentgenol | year= 2000 | volume= 175 | issue= 3 | pages= 649-53 | pmid=10954445 | doi=10.2214/ajr.175.3.1750649 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10954445  }} </ref><ref name="pmid7516653">{{cite journal| author=Bourke G, Owen J, Machet D| title=Histological comparison of the third interdigital nerve in patients with Morton's metatarsalgia and control patients. | journal=Aust N Z J Surg | year= 1994 | volume= 64 | issue= 6 | pages= 421-4 | pmid=7516653 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7516653  }} </ref><ref name="pmid8722878">{{cite journal| author=Wu KK| title=Morton's interdigital neuroma: a clinical review of its etiology, treatment, and results. | journal=J Foot Ankle Surg | year= 1996 | volume= 35 | issue= 2 | pages= 112-9; discussion 187-8 | pmid=8722878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8722878  }} </ref><ref name="pmid31040508">{{cite journal| author=Post MD| title=Mechanical Diagnosis and Therapy and Morton's Neuroma: A Case Report. | journal=Physiother Can | year= 2019 | volume= 71 | issue= 2 | pages= 130-133 | pmid=31040508 | doi=10.3138/ptc.2018-42 | pmc=6484954 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31040508  }} </ref>
|
|
*Symptomatic collapse of the transverse arch by perineural [[fibrosis]] around a plantar digital nerve of the foot due to traction and increased pressure/chronic compression on the interdigital nerve
*[[Symptomatic]] [[collapse]] of the [[Transverse arch of the foot|transverse arch]] by [[Perineural fibroma|perineural]] [[fibrosis]] around a [[plantar]] [[digital nerve]] of the [[foot]] due to [[Traction (orthopedics)|traction]] and increased [[pressure]]/[[Chronic (medical)|chronic]] [[Compression garment|compression]] on the [[Intermetatarsal|interdigital]] [[nerve]]
*Usually located:
*Usually [[Location parameter|located]]:
**Third intermetatarsal space (between third and fourth metatarsals) or  
**[[Third metatarsal bone|Third]] [[intermetatarsal]] [[Space-time|space]] (between [[Third metatarsal bone|third]] and [[Fourth metatarsal bone|fourth metatarsals]]) or
**At the bifurcation of the fourth plantar digital nerve
**At the [[bifurcation]] of the fourth [[plantar]] [[digital nerve]]
*Also known as:
| rowspan="4" |Non-[[neoplastic]]
**Morton’s metatarsalgia
**Plantar interdigital neuroma
**Morton's intermetatarsal neuroma
**Morton's entrapment
**Morton's disease
**Morton's neuropathy
**Morton's neuralgia
**Intermetatarsal neuroma
**Intermetatarsal space neuroma
**Intermetatarsal nerve entrapment
**Interdigital neuroma
**Interdigital nerve compression
**Interdigital nerve enlargement
**Joplin's neuroma
**Plantar neuroma
| rowspan="4" |Non-neoplastic
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Traumatic neuroma'''<ref name="pmid18599222">{{cite journal| author=Foltán R, Klíma K, Spacková J, Sedý J| title=Mechanism of traumatic neuroma development. | journal=Med Hypotheses | year= 2008 | volume= 71 | issue= 4 | pages= 572-6 | pmid=18599222 | doi=10.1016/j.mehy.2008.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18599222  }} </ref><ref name="pmid28915703">{{cite journal| author=Yao C, Zhou X, Zhao B, Sun C, Poonit K, Yan H| title=Treatments of traumatic neuropathic pain: a systematic review. | journal=Oncotarget | year= 2017 | volume= 8 | issue= 34 | pages= 57670-57679 | pmid=28915703 | doi=10.18632/oncotarget.16917 | pmc=5593675 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28915703  }} </ref><ref name="pmid12147981">{{cite journal| author=Colella G, Borriello C, Lanza A, Rossiello R, Siniscalchi G| title=[Traumatic neuroma of the great auricular nerve. A clinical case]. | journal=Minerva Stomatol | year= 2002 | volume= 51 | issue= 6 | pages= 279-83 | pmid=12147981 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12147981  }} </ref><ref name="pmid11010790">{{cite journal| author=Moss CE, Johnston CJ, Whear NM| title=Amputation neuroma of the great auricular nerve after operations on the parotid gland. | journal=Br J Oral Maxillofac Surg | year= 2000 | volume= 38 | issue= 5 | pages= 537-8 | pmid=11010790 | doi=10.1054/bjom.2000.0466 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11010790  }} </ref><ref name="pmid4341800">{{cite journal| author=Hobsley M| title=Amputation neuroma of the great auricular nerve after parotidectomy. | journal=Br J Surg | year= 1972 | volume= 59 | issue= 9 | pages= 735-6 | pmid=4341800 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4341800  }} </ref><ref name="pmid3620156">{{cite journal| author=Toriumi DM, Sykes J, Wolff A| title=Pathologic quiz case 1. Amputation neuroma of the great auricular nerve. | journal=Arch Otolaryngol Head Neck Surg | year= 1987 | volume= 113 | issue= 8 | pages= 888-90 | pmid=3620156 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3620156  }} </ref><ref name="pmid7930014">{{cite journal| author=De Roos KP, Neumann HA| title=Traumatic neuroma. A rare complication following Muller's phlebectomy. | journal=J Dermatol Surg Oncol | year= 1994 | volume= 20 | issue= 10 | pages= 681-2 | pmid=7930014 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7930014  }} </ref><ref name="pmid9745184">{{cite journal| author=Lee EJ, Calcaterra TC, Zuckerbraun L| title=Traumatic neuromas of the head and neck. | journal=Ear Nose Throat J | year= 1998 | volume= 77 | issue= 8 | pages= 670-4, 676 | pmid=9745184 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745184  }} </ref><ref name="pmid22330690">{{cite journal| author=Li Q, Gao EL, Yang YL, Hu HY, Hu XQ| title=Traumatic neuroma in a patient with breast cancer after mastectomy: a case report and review of the literature. | journal=World J Surg Oncol | year= 2012 | volume= 10 | issue=  | pages= 35 | pmid=22330690 | doi=10.1186/1477-7819-10-35 | pmc=3296625 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22330690  }} </ref><ref name="pmid30985684">{{cite journal| author=Chen W, Zhang H, Huang J, Li Y, Zhang Z, Peng Y| title=Traumatic neuroma in mastectomy scar: Two case reports and review of the literature. | journal=Medicine (Baltimore) | year= 2019 | volume= 98 | issue= 15 | pages= e15142 | pmid=30985684 | doi=10.1097/MD.0000000000015142 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30985684  }} </ref><ref name="pmid15490816">{{cite journal| author=Baltalarli B, Demirkan N, Yağci B| title=Traumatic neuroma: unusual benign lesion occurring in the mastectomy scar. | journal=Clin Oncol (R Coll Radiol) | year= 2004 | volume= 16 | issue= 7 | pages= 503-4 | pmid=15490816 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15490816  }} </ref><ref name="pmid10782152">{{cite journal| author=Rosso R, Scelsi M, Carnevali L| title=Granular cell traumatic neuroma: a lesion occurring in mastectomy scars. | journal=Arch Pathol Lab Med | year= 2000 | volume= 124 | issue= 5 | pages= 709-11 | pmid=10782152 | doi=10.1043/0003-9985(2000)124<0709:GCTN>2.0.CO;2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10782152  }} </ref><ref name="pmid12408400">{{cite journal| author=Nomura H, Harimaya K, Orii H, Shiba K, Ueta T, Iwaki T| title=Traumatic neuroma of the anterior cervical nerve root with no subjective episode of trauma. Report of four cases. | journal=J Neurosurg | year= 2002 | volume= 97 | issue= 3 Suppl | pages= 393-6 | pmid=12408400 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12408400  }} </ref><ref name="pmid23187747">{{cite journal| author=Arishima H, Takeuchi H, Tsunetoshi K, Kodera T, Kitai R, Kikuta K| title=Intraoperative and pathological findings of intramedullary amputation neuroma associated with spinal ependymoma. | journal=Brain Tumor Pathol | year= 2013 | volume= 30 | issue= 3 | pages= 196-200 | pmid=23187747 | doi=10.1007/s10014-012-0125-x | pmc=3714552 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23187747  }} </ref><ref name="pmid19834641">{{cite journal| author=Ulrich CT, Sommerlad D, Szelenyi A, Seifert V, Marquardt G| title=Concurrent schwannoma and intradural neuroma after resection of a cauda equina schwannoma. A case report and first description. | journal=Acta Neurochir (Wien) | year= 2010 | volume= 152 | issue= 6 | pages= 1061-3; discussion 1063 | pmid=19834641 | doi=10.1007/s00701-009-0534-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19834641  }} </ref><ref name="pmid23639732">{{cite journal| author=Salas SJ, McFalls JM, Senders ZJ, Kenyon LC, Harrop JS| title=Intradural cervical nerve root traumatic neuroma without a history of direct trauma. | journal=Clin Neurol Neurosurg | year= 2013 | volume= 115 | issue= 9 | pages= 1879-81 | pmid=23639732 | doi=10.1016/j.clineuro.2013.03.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23639732  }} </ref><ref name="pmid27613606">{{cite journal| author=Kang J, Yang P, Zang Q, He X| title=Traumatic neuroma of the superficial peroneal nerve in a patient: a case report and review of the literature. | journal=World J Surg Oncol | year= 2016 | volume= 14 | issue= 1 | pages= 242 | pmid=27613606 | doi=10.1186/s12957-016-0990-6 | pmc=5018173 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27613606  }} </ref>
| style="background:#DCDCDC;" align="center" + |'''[[Trauma|Traumatic]] neuroma'''<ref name="pmid18599222">{{cite journal| author=Foltán R, Klíma K, Spacková J, Sedý J| title=Mechanism of traumatic neuroma development. | journal=Med Hypotheses | year= 2008 | volume= 71 | issue= 4 | pages= 572-6 | pmid=18599222 | doi=10.1016/j.mehy.2008.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18599222  }} </ref><ref name="pmid28915703">{{cite journal| author=Yao C, Zhou X, Zhao B, Sun C, Poonit K, Yan H| title=Treatments of traumatic neuropathic pain: a systematic review. | journal=Oncotarget | year= 2017 | volume= 8 | issue= 34 | pages= 57670-57679 | pmid=28915703 | doi=10.18632/oncotarget.16917 | pmc=5593675 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28915703  }} </ref><ref name="pmid12147981">{{cite journal| author=Colella G, Borriello C, Lanza A, Rossiello R, Siniscalchi G| title=[Traumatic neuroma of the great auricular nerve. A clinical case]. | journal=Minerva Stomatol | year= 2002 | volume= 51 | issue= 6 | pages= 279-83 | pmid=12147981 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12147981  }} </ref><ref name="pmid11010790">{{cite journal| author=Moss CE, Johnston CJ, Whear NM| title=Amputation neuroma of the great auricular nerve after operations on the parotid gland. | journal=Br J Oral Maxillofac Surg | year= 2000 | volume= 38 | issue= 5 | pages= 537-8 | pmid=11010790 | doi=10.1054/bjom.2000.0466 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11010790  }} </ref><ref name="pmid4341800">{{cite journal| author=Hobsley M| title=Amputation neuroma of the great auricular nerve after parotidectomy. | journal=Br J Surg | year= 1972 | volume= 59 | issue= 9 | pages= 735-6 | pmid=4341800 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4341800  }} </ref><ref name="pmid3620156">{{cite journal| author=Toriumi DM, Sykes J, Wolff A| title=Pathologic quiz case 1. Amputation neuroma of the great auricular nerve. | journal=Arch Otolaryngol Head Neck Surg | year= 1987 | volume= 113 | issue= 8 | pages= 888-90 | pmid=3620156 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3620156  }} </ref><ref name="pmid7930014">{{cite journal| author=De Roos KP, Neumann HA| title=Traumatic neuroma. A rare complication following Muller's phlebectomy. | journal=J Dermatol Surg Oncol | year= 1994 | volume= 20 | issue= 10 | pages= 681-2 | pmid=7930014 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7930014  }} </ref><ref name="pmid9745184">{{cite journal| author=Lee EJ, Calcaterra TC, Zuckerbraun L| title=Traumatic neuromas of the head and neck. | journal=Ear Nose Throat J | year= 1998 | volume= 77 | issue= 8 | pages= 670-4, 676 | pmid=9745184 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745184  }} </ref><ref name="pmid22330690">{{cite journal| author=Li Q, Gao EL, Yang YL, Hu HY, Hu XQ| title=Traumatic neuroma in a patient with breast cancer after mastectomy: a case report and review of the literature. | journal=World J Surg Oncol | year= 2012 | volume= 10 | issue=  | pages= 35 | pmid=22330690 | doi=10.1186/1477-7819-10-35 | pmc=3296625 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22330690  }} </ref><ref name="pmid30985684">{{cite journal| author=Chen W, Zhang H, Huang J, Li Y, Zhang Z, Peng Y| title=Traumatic neuroma in mastectomy scar: Two case reports and review of the literature. | journal=Medicine (Baltimore) | year= 2019 | volume= 98 | issue= 15 | pages= e15142 | pmid=30985684 | doi=10.1097/MD.0000000000015142 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30985684  }} </ref><ref name="pmid15490816">{{cite journal| author=Baltalarli B, Demirkan N, Yağci B| title=Traumatic neuroma: unusual benign lesion occurring in the mastectomy scar. | journal=Clin Oncol (R Coll Radiol) | year= 2004 | volume= 16 | issue= 7 | pages= 503-4 | pmid=15490816 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15490816  }} </ref><ref name="pmid10782152">{{cite journal| author=Rosso R, Scelsi M, Carnevali L| title=Granular cell traumatic neuroma: a lesion occurring in mastectomy scars. | journal=Arch Pathol Lab Med | year= 2000 | volume= 124 | issue= 5 | pages= 709-11 | pmid=10782152 | doi=10.1043/0003-9985(2000)124<0709:GCTN>2.0.CO;2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10782152  }} </ref><ref name="pmid12408400">{{cite journal| author=Nomura H, Harimaya K, Orii H, Shiba K, Ueta T, Iwaki T| title=Traumatic neuroma of the anterior cervical nerve root with no subjective episode of trauma. Report of four cases. | journal=J Neurosurg | year= 2002 | volume= 97 | issue= 3 Suppl | pages= 393-6 | pmid=12408400 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12408400  }} </ref><ref name="pmid23187747">{{cite journal| author=Arishima H, Takeuchi H, Tsunetoshi K, Kodera T, Kitai R, Kikuta K| title=Intraoperative and pathological findings of intramedullary amputation neuroma associated with spinal ependymoma. | journal=Brain Tumor Pathol | year= 2013 | volume= 30 | issue= 3 | pages= 196-200 | pmid=23187747 | doi=10.1007/s10014-012-0125-x | pmc=3714552 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23187747  }} </ref><ref name="pmid19834641">{{cite journal| author=Ulrich CT, Sommerlad D, Szelenyi A, Seifert V, Marquardt G| title=Concurrent schwannoma and intradural neuroma after resection of a cauda equina schwannoma. A case report and first description. | journal=Acta Neurochir (Wien) | year= 2010 | volume= 152 | issue= 6 | pages= 1061-3; discussion 1063 | pmid=19834641 | doi=10.1007/s00701-009-0534-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19834641  }} </ref><ref name="pmid23639732">{{cite journal| author=Salas SJ, McFalls JM, Senders ZJ, Kenyon LC, Harrop JS| title=Intradural cervical nerve root traumatic neuroma without a history of direct trauma. | journal=Clin Neurol Neurosurg | year= 2013 | volume= 115 | issue= 9 | pages= 1879-81 | pmid=23639732 | doi=10.1016/j.clineuro.2013.03.018 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23639732  }} </ref><ref name="pmid27613606">{{cite journal| author=Kang J, Yang P, Zang Q, He X| title=Traumatic neuroma of the superficial peroneal nerve in a patient: a case report and review of the literature. | journal=World J Surg Oncol | year= 2016 | volume= 14 | issue= 1 | pages= 242 | pmid=27613606 | doi=10.1186/s12957-016-0990-6 | pmc=5018173 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27613606  }} </ref>
|
|
*Arises from nerve injury (often as a result of surgery) leading to interrupted axons termed as neurotmesis
*Arises from [[nerve injury]] (often as a [[result]] of [[surgery]]) [[Lead|leading]] to interrupted [[axons]] [[Term logic|termed]] as [[neurotmesis]]
*Regenerating axons lack an endoneurial tube to follow, resulting in a painful and tender mass of disorganized axons  
*[[Regenerate|Regenerating]] [[axons]] [[Lack (manque)|lack]] an [[Endoneurium|endoneurial]] tube to follow, [[Result|resulting]] in a [[painful]] and [[Tenderness|tender]] [[mass]] of disorganized [[axons]]
*Occurs at the end of injured nerve fibers as a form of unregulated nerve regeneration
*Occurs at the end of [[Injury|injured]] [[nerve]] [[Fiber|fibers]] as a form of unregulated [[nerve regeneration]]
*Subtype of traumatic neuroma, called "Joplin neuroma" (a compression traumatic neuroma)
*Subtype of [[Trauma|traumatic]] neuroma, called "Joplin neuroma" (a [[Compressibility|compression]] [[Trauma|traumatic]] neuroma)
*Occurs most commonly near a [[scar]]
*Occurs most commonly near a [[scar]]
*Often very painful
*Often very [[painful]]
*Also known as:
*Also known as:
**Amputation neuroma
**[[Amputation]] neuroma
**Pseudoneuroma
**Pseudoneuroma
**Scar neuroma
**[[Scar]] neuroma
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Palisaded encapsulated neuroma/solitary circumscribed neuroma'''
| style="background:#DCDCDC;" align="center" + |'''Palisaded encapsulated neuroma/[[solitary]] circumscribed neuroma'''
|
|
* Nonpigmented, painless, small, firm nodules
* Nonpigmented, painless, small, firm [[nodules]]
* Present in proximity to mucocutaneous junctions, usually face
*[[Presenting symptom|Present]] in proximity to [[mucocutaneous]] junctions, usually [[face]]
* Benign but can be mistaken for basal cell carcinoma
*[[Benign]] but can be mistaken for [[basal cell carcinoma]]
* Surgical removal is the curative treatment
*[[Surgery|Surgical]] removal is the [[Cure|curative]] [[Treatments|treatment]]
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Mucosal neuroma'''<ref name="pmid15177321">{{cite journal| author=Golan JD, Jacques L| title=Nonneoplastic peripheral nerve tumors. | journal=Neurosurg Clin N Am | year= 2004 | volume= 15 | issue= 2 | pages= 223-30 | pmid=15177321 | doi=10.1016/j.nec.2004.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15177321  }} </ref><ref name="pmid7824936">{{cite journal| author=Santoro M, Carlomagno F, Romano A, Bottaro DP, Dathan NA, Grieco M et al.| title=Activation of RET as a dominant transforming gene by germline mutations of MEN2A and MEN2B. | journal=Science | year= 1995 | volume= 267 | issue= 5196 | pages= 381-3 | pmid=7824936 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7824936  }} </ref>
| style="background:#DCDCDC;" align="center" + |'''[[Mucosal]] neuroma'''<ref name="pmid15177321">{{cite journal| author=Golan JD, Jacques L| title=Nonneoplastic peripheral nerve tumors. | journal=Neurosurg Clin N Am | year= 2004 | volume= 15 | issue= 2 | pages= 223-30 | pmid=15177321 | doi=10.1016/j.nec.2004.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15177321  }} </ref><ref name="pmid7824936">{{cite journal| author=Santoro M, Carlomagno F, Romano A, Bottaro DP, Dathan NA, Grieco M et al.| title=Activation of RET as a dominant transforming gene by germline mutations of MEN2A and MEN2B. | journal=Science | year= 1995 | volume= 267 | issue= 5196 | pages= 381-3 | pmid=7824936 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7824936  }} </ref>
|
|
* Associated with MEN2B (inherited autosomal dominant trait caused by a single mutation in RET proto-oncogene)
*[[Association (statistics)|Associated]] with [[Multiple endocrine neoplasia type 2|MEN2B]] ([[inherited]] [[autosomal dominant]] [[Trait (biology)|trait]] [[Causes|caused]] by a single [[mutation]] in [[RET proto-oncogene]])
* Grossly present as:
*[[Gross|Grossly]] present as:
* Diffusely enlarged lips
**[[Diffuse|Diffusely]] enlarged [[lips]]
* Tongue nodules
**[[Tongue]] [[nodules]]
* Thickened eyelids (diffusely or nodularly), in the first or second decade of life
**[[Thickener|Thickened]] [[eyelids]] ([[Diffuse|diffusely]] or [[Nodular|nodularly]]), in the first or second decade of [[life]]
* Comprised of markedly enlarged nerve fibers on microscopy
** Comprised of markedly enlarged [[nerve fibers]] on [[microscopy]]
* No specific treatment
* No [[Specific activity|specific]] [[Treatments|treatment]]
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Neoplasic neuroma'''
| style="background:#DCDCDC;" align="center" + |'''[[Neoplasic diseases|Neoplasic]] neuroma'''
|
|
*Solid nodular mass  
*[[Solid]] [[nodular]] [[mass]]
*Usually, separate from nerve fibers
*Usually, separate from [[nerve fibers]]
| rowspan="4" |Neoplastic
| rowspan="4" |[[Neoplastic]]
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Acoustic neuroma''' <ref name="pmid31068992">{{cite journal| author=Thapa PB, Shahi S, Jha RK, Shrestha D| title=Vestibular Schwanomma: An Experience in a Developing World. | journal=World J Oncol | year= 2019 | volume= 10 | issue= 2 | pages= 118-122 | pmid=31068992 | doi=10.14740/wjon1195 | pmc=6497013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31068992  }} </ref>
| style="background:#DCDCDC;" align="center" + |'''[[Acoustic neuroma]]''' <ref name="pmid31068992">{{cite journal| author=Thapa PB, Shahi S, Jha RK, Shrestha D| title=Vestibular Schwanomma: An Experience in a Developing World. | journal=World J Oncol | year= 2019 | volume= 10 | issue= 2 | pages= 118-122 | pmid=31068992 | doi=10.14740/wjon1195 | pmc=6497013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31068992  }} </ref>
|
|
* It's a misnomer
* It's a misnomer
* It's actually a Vestibular Schwannoma
* It's actually a [[Vestibular system|Vestibular]] [[Schwannoma]]
* Slow-growing, benign tumor of acoustic nerve
*[[Slow]]-[[Growth|growing]], [[benign tumor]] of [[acoustic nerve]]
* Symptoms usually start after the age of 30 and include:
*[[Symptoms]] usually start after the [[age]] of 30 and include:
** Dizziness
**[[Dizziness]]
** Persistent headaches
** Persistent [[headaches]]
** Vertigo
**[[Vertigo]]
** Loss of balance
**[[Loss of balance]]
** Tinnitis
**[[Tinnitis]]
** Numbness
**[[Numbness]]
** Pain/weakness on one side of face
**[[Pain]]/[[weakness]] on one side of [[face]]
** Blurred/double vision (temporary)
**[[Blurred vision|Blurred]]/[[double vision]] (temporary)
** Ataxia
**[[Ataxia]]
** Hoarseness of voice
**[[Hoarseness]] of [[voice]]
** Dysphagia
**[[Dysphagia]]
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Ganglioneuroma'''
| style="background:#DCDCDC;" align="center" + |'''[[Ganglioneuroma]]'''
|
|
* Tumor of sympathetic nerve fibers arising from neural crest cells
*[[Tumor]] of [[sympathetic]] [[nerve fibers]] arising from [[neural crest cells]]
|-
|-
| style="background:#DCDCDC;" align="center" + |'''Pacinian neuroma'''<ref name="pmid21082159">{{cite journal| author=Zanardi F, Cooke RM, Maiorana A, Curti S, Farioli A, Bonfiglioli R et al.| title="Is this case of a very rare disease work-related?" A review of reported cases of Pacinian neuroma. | journal=Scand J Work Environ Health | year= 2011 | volume= 37 | issue= 3 | pages= 253-8 | pmid=21082159 | doi=10.5271/sjweh.3132 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21082159  }} </ref><ref name="pmid22211094">{{cite journal| author=Cho HH, Hong JS, Park SY, Park HS, Cho S, Lee JH| title=Tender papule rising on the digit: Pacinian neuroma should be considered in differential diagnosis. | journal=Int J Med Sci | year= 2012 | volume= 9 | issue= 1 | pages= 83-5 | pmid=22211094 | doi= | pmc=3245416 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22211094  }} </ref><ref name="pmid17008055">{{cite journal| author=Ide F, Shimoyama T, Kaneko T, Horie N| title=Pacinian neuroma in adipose herniation of the buccal mucosa. | journal=Int J Oral Maxillofac Surg | year= 2006 | volume= 35 | issue= 12 | pages= 1162-3 | pmid=17008055 | doi=10.1016/j.ijom.2006.06.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17008055  }} </ref><ref name="pmid1154066">{{cite journal| author=Rhode CM, Jennings WD| title=Pacinian corpuscle neuroma of digital nerves. | journal=South Med J | year= 1975 | volume= 68 | issue= 1 | pages= 86-9 | pmid=1154066 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1154066  }} </ref>
| style="background:#DCDCDC;" align="center" + |'''[[Pacinian corpuscle|Pacinian]] neuroma'''<ref name="pmid21082159">{{cite journal| author=Zanardi F, Cooke RM, Maiorana A, Curti S, Farioli A, Bonfiglioli R et al.| title="Is this case of a very rare disease work-related?" A review of reported cases of Pacinian neuroma. | journal=Scand J Work Environ Health | year= 2011 | volume= 37 | issue= 3 | pages= 253-8 | pmid=21082159 | doi=10.5271/sjweh.3132 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21082159  }} </ref><ref name="pmid22211094">{{cite journal| author=Cho HH, Hong JS, Park SY, Park HS, Cho S, Lee JH| title=Tender papule rising on the digit: Pacinian neuroma should be considered in differential diagnosis. | journal=Int J Med Sci | year= 2012 | volume= 9 | issue= 1 | pages= 83-5 | pmid=22211094 | doi= | pmc=3245416 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22211094  }} </ref><ref name="pmid17008055">{{cite journal| author=Ide F, Shimoyama T, Kaneko T, Horie N| title=Pacinian neuroma in adipose herniation of the buccal mucosa. | journal=Int J Oral Maxillofac Surg | year= 2006 | volume= 35 | issue= 12 | pages= 1162-3 | pmid=17008055 | doi=10.1016/j.ijom.2006.06.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17008055  }} </ref><ref name="pmid1154066">{{cite journal| author=Rhode CM, Jennings WD| title=Pacinian corpuscle neuroma of digital nerves. | journal=South Med J | year= 1975 | volume= 68 | issue= 1 | pages= 86-9 | pmid=1154066 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1154066  }} </ref>
|
|
* Very rare
* Very [[rare]]
* Painful
*[[Painful]]
* Benign hyperplastic tumor of Pacinian corpuscles (mechanoreceptors responsible for sensitivity to vibration and pressure)
*[[Benign]] [[hyperplastic]] [[tumor]] of [[Pacinian corpuscles]] ([[mechanoreceptors]] responsible for [[sensitivity]] to [[vibration]] and [[pressure]])
* Sometimes associated with history of local trauma
* Sometimes [[Association (statistics)|associated]] with history of [[local]] [[trauma]]
|}
|}


==Pathophysiology==
==Pathophysiology==
*The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*The [[pathogenesis]] of neuroma is [[Characterization (mathematics)|characterized]] by [[neural]] [[degeneration]] with [[Epineurium|epineural]] and [[Endoneurium|endoneural]] [[vascular]] [[Hyaline|hyalinization]], and [[Perineurium|perineural]] [[fibrosis]]<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*The pathogenesis of traumatic neuroma is characterized by:<ref name="pmid20224738">{{cite journal| author=Kitcat M, Hunter JE, Malata CM| title=Sciatic neuroma presenting forty years after above-knee amputation. | journal=Open Orthop J | year= 2009 | volume= 3 | issue=  | pages= 125-7 | pmid=20224738 | doi=10.2174/1874325000903010125 | pmc=2835865 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20224738  }} </ref><ref name="pmid9745184">{{cite journal| author=Lee EJ, Calcaterra TC, Zuckerbraun L| title=Traumatic neuromas of the head and neck. | journal=Ear Nose Throat J | year= 1998 | volume= 77 | issue= 8 | pages= 670-4, 676 | pmid=9745184 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745184  }} </ref><ref name="pmid27179535">{{cite journal| author=Hanna SA, Catapano J, Borschel GH| title=Painful pediatric traumatic neuroma: surgical management and clinical outcomes. | journal=Childs Nerv Syst | year= 2016 | volume= 32 | issue= 7 | pages= 1191-4 | pmid=27179535 | doi=10.1007/s00381-016-3109-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27179535  }} </ref>
*The [[pathogenesis]] of [[Trauma|traumatic]] neuroma is [[Characterization (mathematics)|characterized]] by:<ref name="pmid20224738">{{cite journal| author=Kitcat M, Hunter JE, Malata CM| title=Sciatic neuroma presenting forty years after above-knee amputation. | journal=Open Orthop J | year= 2009 | volume= 3 | issue=  | pages= 125-7 | pmid=20224738 | doi=10.2174/1874325000903010125 | pmc=2835865 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20224738  }} </ref><ref name="pmid9745184">{{cite journal| author=Lee EJ, Calcaterra TC, Zuckerbraun L| title=Traumatic neuromas of the head and neck. | journal=Ear Nose Throat J | year= 1998 | volume= 77 | issue= 8 | pages= 670-4, 676 | pmid=9745184 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745184  }} </ref><ref name="pmid27179535">{{cite journal| author=Hanna SA, Catapano J, Borschel GH| title=Painful pediatric traumatic neuroma: surgical management and clinical outcomes. | journal=Childs Nerv Syst | year= 2016 | volume= 32 | issue= 7 | pages= 1191-4 | pmid=27179535 | doi=10.1007/s00381-016-3109-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27179535  }} </ref>
**Tangle of neural fibers and connective tissue that develops following a peripheral nerve injury
**Tangle of [[neural]] [[Fiber|fibers]] and [[connective tissue]] that [[Development (biology)|develops]] following a [[peripheral nerve]] [[injury]]
**Interruption in continuity of nerve causing wallerian degeneration (loss of axons in proximal stump and retraction of axons in distal segment), followed by exuberant regeneration of nerve and formation of mass of Schwann cells, axons and fibrous cells
**Interruption in continuity of [[nerve]] [[Causes|causing]] [[wallerian degeneration]] ([[Loss function|loss]] of [[axons]] in [[proximal]] stump and [[retraction]] of [[axons]] in [[distal]] segment), followed by exuberant [[regeneration]] of [[nerve]] and [[Formation matrix|formation]] of [[mass]] of [[Schwann cells]], [[axons]] and [[fibrous]] [[Cells (biology)|cells]]
**Chronic reactive fibroinflammatory disorganized regeneration around a nerve after an injury (such as traction injury or chronic repetitive stress)
**[[Chronic (medical)|Chronic]] [[Reaction|reactive]] fibroinflammatory disorganized [[Regeneration (biology)|regeneration]] around a [[nerve]] after an [[injury]] (such as [[Traction (orthopedics)|traction]] [[injury]] or [[Chronic (medical)|chronic]] [[Repetitive stress injury|repetitive stress]])
*Morton neuroma is characterized by being located in the 3rd web-space, between 3rd and 4th [[Metatarsals|metatarsal]] heads,<ref>{{cite book | last = Perry | first = Arie | title = Practical surgical neuropathology : a diagnostic approach | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0443069826 }}</ref> or sometimes in the second or fourth interspaces
*[[Morton's neuroma]] is [[Characterization (mathematics)|characterized]] by being [[Location parameter|located]] in the 3rd web-space, between 3rd and 4th [[Metatarsals|metatarsal]] [[Head|heads]], or sometimes in the second or fourth [[Intermetatarsal|interspaces]]
*Another subtype of traumatic neuroma is terminal neuroma (also known as "stump neuroma") which can occur after transection of the nerve (e.g. limb [[amputation]])  
*Another subtype of [[Trauma|traumatic]] neuroma is terminal neuroma (also known as "stump neuroma") which can occur after [[transection]] of the [[nerve]] (e.g. [[limb]] [[amputation]])
*There are no genetic mutations associated with the development of neuroma  
*There are no [[genetic mutations]] [[Association (statistics)|associated]] with the [[Development (biology)|development]] of neuroma
*On gross pathology, characteristic findings of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*On [[gross pathology]], [[Characteristic impedance|characteristic]] findings of neuroma, includes:<ref>{{cite book | last = Perry | first = Arie | title = Practical surgical neuropathology : a diagnostic approach | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0443069826 }}</ref> <ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
**Adherent fibrofatty tissue
**Adherent fibrofatty [[Tissue (biology)|tissue]]
**Small, firm, [[oval]], yellowish-white, [[Slow|slowly]] [[Growth|growing]], [[palpable]] [[nodule]] on [[skin]] (no discoloration of [[skin]] on the top of [[nodule]])
**Small, firm, [[oval]], yellowish-white, [[Slow|slowly]] [[Growth|growing]], [[palpable]] [[nodule]] on [[skin]] (no discoloration of [[skin]] on the [[Top7|top]] of [[nodule]])
**</=2cm in [[Size consistency|size]]
**</=2cm in [[Size consistency|size]]
*On microscopic histopathological analysis, characteristic findings of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*On [[microscopic]] [[histopathological]] [[analysis]], [[Characteristic impedance|characteristic]] findings of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
**Extensive fibrosis around and within the nerve
**Extensive [[fibrosis]] around and within the [[nerve]]
**Digital artery
**Digital [[artery]]
**[[Thrombosis]]
**[[Thrombosis]]
**Arterial thickening  
**[[Arterial]] [[Thickener|thickening]]
 
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===Histopathology of traumatic neuroma===
===Histopathology of traumatic neuroma===
*Numerous well formed small nerve twigs
*Numerous well formed small [[nerve]] twigs
*Limited soft tissue infiltration
*Limited [[soft tissue]] [[Infiltration (medical)|infiltration]]
*Contains axons in haphazardly arranged nerves within mature collagenous scar with entrapped smooth muscle
*Contains [[axons]] in haphazardly arranged [[nerves]] within mature [[collagenous]] [[scar]] with entrapped [[smooth muscle]]
 
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[[File:1024px-Skin Tumors-PA291031.jpg|thumb|200px|none| Traumatic neuroma [https://commons.wikimedia.org/wiki/Category:Histopathology_of_neuromas_in_the_skin#/media/File:Skin_Tumors-PA291031.jpg]]]
[[File:1024px-Skin Tumors-PA291031.jpg|thumb|200px|none| Traumatic neuroma [https://commons.wikimedia.org/wiki/Category:Histopathology_of_neuromas_in_the_skin#/media/File:Skin_Tumors-PA291031.jpg]]]
|}
===Histopathology of Morton neuroma===
*On gross pathology, morton neuroma resembles traumatic neuroma
*On histopathology, it is comprised of:
**Degenerated/demyelinated axons
**Vascular hyalinization
**Fibrosis
[[File:Morton neuroma -- low mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, low magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_--_low_mag.jpg]]]
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[[File:Morton neuroma - alt -- high mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, High magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_-_alt_--_high_mag.jpg]]]
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[[File:Morton neuroma - alt 1 -- intermed mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, Intermediate magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_-_alt_1_--_intermed_mag.jpg]]]
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[[File:Morton neuroma - alt 2 -- intermed mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, Intermediate magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_-_alt_2_--_intermed_mag.jpg]]]
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[[File:Morton neuroma -- high mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, High magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_--_high_mag.jpg]]]
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[[File:Morton neuroma -- very high mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, very high magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_--_very_high_mag.jpg]]]
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[[File:Morton neuroma -- intermed mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, Intermediate magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_--_intermed_mag.jpg]]]
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===Common sites of involvement by traumatic neuroma===
===Common sites of involvement by traumatic neuroma===
*Most common oral locations are:
*Most common [[oral]] [[Location parameter|locations]] are:
**Tongue
**[[Tongue]]
**Near mental foramen of mouth
**Near [[mental foramen]] of [[mouth]]
*Rarely involves:
*[[Rare|Rarely]] involves:
**Head
**[[Head]]
**Neck
**[[Neck]]


==Causes==
==Causes==
*Common causes of neuroma include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*Common [[causes]] of neuroma include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
**Indirect nerve trauma
**Indirect [[nerve]] [[trauma]]
*** Especially during a [[surgery]]
*** Especially during a [[surgery]]
*** [[Cone biopsy]] ([[rare]] [[Complications|complication]])
***[[Cone biopsy]] ([[rare]] [[Complications|complication]])
*** 55% of [[hysterectomy]] [[patients]] have microneuromas, associated with [[childbirth]]
*** 55% of [[hysterectomy]] [[patients]] have microneuromas, [[Association (statistics)|associated]] with [[childbirth]]
*** Traction injury
***[[Traction (orthopedics)|Traction]] [[injury]]
***Chronic repetitive stress
***[[Chronic (medical)|Chronic]] [[Repetitive stress injury|repetitive stress]]
*Morton's neuroma is associated with:
*[[Morton's neuroma]] is [[Association (statistics)|associated]] with:
**[[Wear red day|Wearing]] tight [[Shoe insert|shoes]] and high [[Heel|heels]]
**Overpronation
**Overpronation
**Tight shoes
**[[Abnormal]] [[Position effect|positioning]] of [[toes]]
 
**[[Flat feet]]
==Differentiating Neuroma  from other Diseases==
**[[Foot|Forefoot]] [[Problem Solved|problems]] such as:
*Neuroma must be differentiated from other diseases that cause forefoot pain and numbness such as:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
***[[Bunion|Bunions]]
:*[[Stress fracture]] (neck of the metatarsal)
***[[Hammer toe|Hammer toes]]
:*[[Rheumatoid arthritis]]  
**High [[Arches of the foot|foot arches]]
:*[[Plexiform neurofibroma]]
:*Hammertoe
:*[[Neurofibroma]]


==Epidemiology and Demographics==
==Epidemiology and Demographics==
*Neuroma is a uncommon disease<ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*Neuroma is an uncommon [[disease]]<ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>


===Age===
===Age===
*Neuroma is more commonly observed among patients aged between 15 to 50 years old<ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*Neuroma is more commonly [[Observation|observed]] among [[patients]] [[Age|aged]] between 15 to 50 [[Year|years]] old<ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*Neuroma is more commonly observed among middle aged adults  
*Neuroma is more commonly [[Observation|observed]] among [[Middle age|middle aged]] [[Adult|adults]]
   
   
===Gender===
===Gender===
*Females are more commonly affected with neuroma than males  
*[[Females]] are more commonly [[Affect|affected]] with neuroma than [[males]]
*The female to male ratio is approximately 5:1<ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>  
*The [[female]] to [[male]] [[ratio]] is approximately 5:1<ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
   
   
===Race===
===Race===
*There is no racial predilection for neuroma
*There is no [[racial]] predilection for neuroma


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of neuroma include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref>
*Common [[risk factors]] in the [[development]] of neuroma include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref>
:*Improper footwear/tight shoes
**[[Improper rotation|Improper]] [[Foot|footwear]]/tight [[Shoe insert|shoes]]
:*High-impact sports (e.g., rock-climbing, ballet dancing)
**High-[[Impacted|impact]] [[Sports medicine|sports]] (e.g., [[Rock climbing|rock-climbing]], ballet dancing, jogging, [[running]], [[snow]] skiing)
:*Overpronation
**Overpronation


== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with neuroma are symptomatic at the time of diagnosis<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*The majority of [[patients]] with neuroma are [[symptomatic]] at the [[Time constant|time]] of [[diagnosis]]<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Early clinical features include neuropathic pain or local [[tenderness]]
*Early [[clinical]] [[Features (pattern recognition)|features]] include [[neuropathic pain]] or [[local]] [[tenderness]]
*If left untreated, the majority of patients with neuroma may progress to develop [[difficulty walking]] and [[limping]]  
*If left untreated, the majority of [[patients]] with neuroma may progress to [[Development (biology)|develop]] [[difficulty walking]] and [[limping]]
*A significant complication of neuroma is chronic [[neuropathic pain]]  
*A [[Significant figure|significant]] [[Complication (medicine)|complication]] of neuroma is chronic [[neuropathic pain]]
*Prognosis is generally good, and the survival rate of patients with neuroma is 99%<ref name="pmid22134434">{{cite journal| author=Lee KT, Kim JB, Young KW, Park YU, Kim JS, Jegal H| title=Long-term results of neurectomy in the treatment of Morton's neuroma: more than 10 years' follow-up. | journal=Foot Ankle Spec | year= 2011 | volume= 4 | issue= 6 | pages= 349-53 | pmid=22134434 | doi=10.1177/1938640011428510 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22134434  }} </ref><ref name="pmid25481724">{{cite journal| author=Bauer T, Gaumetou E, Klouche S, Hardy P, Maffulli N| title=Metatarsalgia and Morton's Disease: Comparison of Outcomes Between Open Procedure and Neurectomy Versus Percutaneous Metatarsal Osteotomies and Ligament Release With a Minimum of 2 Years of Follow-Up. | journal=J Foot Ankle Surg | year= 2015 | volume= 54 | issue= 3 | pages= 373-7 | pmid=25481724 | doi=10.1053/j.jfas.2014.08.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25481724  }} </ref>
*[[Prognosis]] is generally good, and the [[survival rate]] of [[patients]] with neuroma is 99%<ref name="pmid22134434">{{cite journal| author=Lee KT, Kim JB, Young KW, Park YU, Kim JS, Jegal H| title=Long-term results of neurectomy in the treatment of Morton's neuroma: more than 10 years' follow-up. | journal=Foot Ankle Spec | year= 2011 | volume= 4 | issue= 6 | pages= 349-53 | pmid=22134434 | doi=10.1177/1938640011428510 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22134434  }} </ref><ref name="pmid25481724">{{cite journal| author=Bauer T, Gaumetou E, Klouche S, Hardy P, Maffulli N| title=Metatarsalgia and Morton's Disease: Comparison of Outcomes Between Open Procedure and Neurectomy Versus Percutaneous Metatarsal Osteotomies and Ligament Release With a Minimum of 2 Years of Follow-Up. | journal=J Foot Ankle Surg | year= 2015 | volume= 54 | issue= 3 | pages= 373-7 | pmid=25481724 | doi=10.1053/j.jfas.2014.08.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25481724  }} </ref>


== Diagnosis ==
== Diagnosis ==
=== Symptoms ===
=== Symptoms ===
*Neuroma  is usually asymptomatic
*Neuroma  is usually [[asymptomatic]]
*Symptoms of neuroma may include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*[[Symptoms]] of neuroma may include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
**Focal area of [[Trauma|traumatic]] [[neuropathic]] [[pain]] radiating to toes, with the presence of a [[Typical set|typical]] [[trigger point]] in the [[area]] of a [[neuroma]] (especially with the [[pressure]] application) [[Causality|causing]] the [[patient]] to feel burning, stabbing, [[raw]], gnawing or sickening [[sensations]]<ref name="pmid8478796">{{cite journal| author=Locke RK| title=Morton's neuroma. | journal=J Am Podiatr Med Assoc | year= 1993 | volume= 83 | issue= 2 | pages= 108-9 | pmid=8478796 | doi=10.7547/87507315-83-2-108 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8478796  }} </ref>
**Focal [[area]] of [[Trauma|traumatic]] [[neuropathic]] [[pain]] [[Radiation|radiating]] to [[toes]], with the presence of a [[Typical set|typical]] [[trigger point]] in the [[area]] of a neuroma (especially with the [[pressure]] application) [[Causality|causing]] the [[patient]] to [[Feeling|feel]]:<ref name="pmid8478796">{{cite journal| author=Locke RK| title=Morton's neuroma. | journal=J Am Podiatr Med Assoc | year= 1993 | volume= 83 | issue= 2 | pages= 108-9 | pmid=8478796 | doi=10.7547/87507315-83-2-108 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8478796  }} </ref>
***Shooting
***[[Burn|Burning]]
***Stabbing
***[[Raw]]
***Gnawing
***[[Sick|Sickening]] [[sensations]]
**[[Numbness]]
**[[Paresthesias|Paresthesia]] over the [[Injured reserve list|injured]] [[area]]
**[[Paresthesias|Paresthesia]] over the [[Injured reserve list|injured]] [[area]]
**[[Dysesthesia]] ([[painful]] [[hypersensitivity]] to normal [[light]] [[tactile]] [[Stimulants|stimuli]])
**[[Dysesthesia]] ([[painful]] [[hypersensitivity]] to normal [[light]] [[tactile]] [[Stimulants|stimuli]])
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=== Physical Examination ===
=== Physical Examination ===
*Patients with neuroma usually appear with antalgic posture<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*[[Patients]] with neuroma usually [[Appearance|appear]] with antalgic [[posture]]<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Physical examination may be remarkable for:
*[[Physical examination]] may be remarkable for:
:*[[Tenderness]] to palpation
**[[Tenderness]] to [[palpation]]
:*Limitation of range of motion
**Limitation of [[range of motion]]
:*[[Pain|Dysesthetic pain]]  
**[[Pain|Dysesthetic pain]]
:*Mulder's sign:
**[[Mulder's sign]]:
:**Clicking sensation in the involved interspace on palpation with simultaneous squeezing of metatarsal joints
***[[Replication]] of [[symptoms]] or clicking [[sensations]] upon direct [[pressure]] between the [[metatarsal]] [[Head|heads]] or [[Compressibility|compression]] of [[Transverse arch of the foot|transverse arch in forefoot]] between the [[finger]] and [[thumb]]


=== Laboratory Findings ===
=== Laboratory Findings ===
*There are no specific laboratory findings associated with neuroma<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref>
*There are no [[Specific activity|specific]] [[Laboratory findings template|laboratory findings]] [[Association (statistics)|associated]] with neuroma<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref>
   
   
===Imaging Findings===
===Imaging Findings===
====MRI====
====MRI====
*On MRI, characteristic findings of neuroma include:<ref name="pmid26901025">{{cite journal| author=AlSharif S, Ferré R, Omeroglu A, El Khoury M, Mesurolle B| title=Imaging Features Associated With Posttraumatic Breast Neuromas. | journal=AJR Am J Roentgenol | year= 2016 | volume= 206 | issue= 3 | pages= 660-5 | pmid=26901025 | doi=10.2214/AJR.14.14035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26901025  }} </ref><ref name="pmid26188658">{{cite journal| author=Ahlawat S, Belzberg AJ, Montgomery EA, Fayad LM| title=MRI features of peripheral traumatic neuromas. | journal=Eur Radiol | year= 2016 | volume= 26 | issue= 4 | pages= 1204-12 | pmid=26188658 | doi=10.1007/s00330-015-3907-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26188658  }} </ref><ref name="pmid9016241">{{cite journal| author=Zanetti M, Ledermann T, Zollinger H, Hodler J| title=Efficacy of MR imaging in patients suspected of having Morton's neuroma. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 2 | pages= 529-32 | pmid=9016241 | doi=10.2214/ajr.168.2.9016241 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9016241  }} </ref><ref name="pmid9022580">{{cite journal| author=Williams JW, Meaney J, Whitehouse GH, Klenerman L, Hussein Z| title=MRI in the investigation of Morton's neuroma: which sequences? | journal=Clin Radiol | year= 1997 | volume= 52 | issue= 1 | pages= 46-9 | pmid=9022580 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9022580  }} </ref><ref name="pmid1619223">{{cite journal| author=Unger HR, Mattoso PQ, Drusen MJ, Neumann CH| title=Gadopentetate-enhanced magnetic resonance imaging with fat saturation in the evaluation of Morton's neuroma. | journal=J Foot Surg | year= 1992 | volume= 31 | issue= 3 | pages= 244-6 | pmid=1619223 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1619223  }} </ref><ref name="pmid17420632">{{cite journal| author=Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee JW et al.| title=Morton neuroma: evaluated with ultrasonography and MR imaging. | journal=Korean J Radiol | year= 2007 | volume= 8 | issue= 2 | pages= 148-55 | pmid=17420632 | doi=10.3348/kjr.2007.8.2.148 | pmc=2626779 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17420632  }} </ref><ref name="pmid12601213">{{cite journal| author=Weishaupt D, Treiber K, Kundert HP, Zollinger H, Vienne P, Hodler J et al.| title=Morton neuroma: MR imaging in prone, supine, and upright weight-bearing body positions. | journal=Radiology | year= 2003 | volume= 226 | issue= 3 | pages= 849-56 | pmid=12601213 | doi=10.1148/radiol.2263011925 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12601213  }} </ref><ref name="pmid22719120">{{cite journal| author=Torres-Claramunt R, Ginés A, Pidemunt G, Puig L, de Zabala S| title=MRI and ultrasonography in Morton's neuroma: Diagnostic accuracy and correlation. | journal=Indian J Orthop | year= 2012 | volume= 46 | issue= 3 | pages= 321-5 | pmid=22719120 | doi=10.4103/0019-5413.96390 | pmc=3377144 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22719120  }} </ref><ref name="pmid10954445">{{cite journal| author=Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E| title=Morton's neuroma: is it always symptomatic? | journal=AJR Am J Roentgenol | year= 2000 | volume= 175 | issue= 3 | pages= 649-53 | pmid=10954445 | doi=10.2214/ajr.175.3.1750649 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10954445  }} </ref><ref name="pmid12112506">{{cite journal| author=Weishaupt D, Treiber K, Jacob HA, Kundert HP, Hodler J, Marincek B et al.| title=MR imaging of the forefoot under weight-bearing conditions: position-related changes of the neurovascular bundles and the metatarsal heads in asymptomatic volunteers. | journal=J Magn Reson Imaging | year= 2002 | volume= 16 | issue= 1 | pages= 75-84 | pmid=12112506 | doi=10.1002/jmri.10130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12112506  }} </ref><ref name="pmid18195378">{{cite journal| author=Studler U, Mengiardi B, Bode B, Schöttle PB, Pfirrmann CW, Hodler J et al.| title=Fibrosis and adventitious bursae in plantar fat pad of forefoot: MR imaging findings in asymptomatic volunteers and MR imaging-histologic comparison. | journal=Radiology | year= 2008 | volume= 246 | issue= 3 | pages= 863-70 | pmid=18195378 | doi=10.1148/radiol.2463070196 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18195378  }} </ref><ref name="pmid10954445">{{cite journal| author=Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E| title=Morton's neuroma: is it always symptomatic? | journal=AJR Am J Roentgenol | year= 2000 | volume= 175 | issue= 3 | pages= 649-53 | pmid=10954445 | doi=10.2214/ajr.175.3.1750649 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10954445  }} </ref>
*On [[Magnetic resonance imaging|MRI]], [[Characteristic impedance|characteristic]] findings of neuroma include:<ref name="pmid26901025">{{cite journal| author=AlSharif S, Ferré R, Omeroglu A, El Khoury M, Mesurolle B| title=Imaging Features Associated With Posttraumatic Breast Neuromas. | journal=AJR Am J Roentgenol | year= 2016 | volume= 206 | issue= 3 | pages= 660-5 | pmid=26901025 | doi=10.2214/AJR.14.14035 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26901025  }} </ref><ref name="pmid26188658">{{cite journal| author=Ahlawat S, Belzberg AJ, Montgomery EA, Fayad LM| title=MRI features of peripheral traumatic neuromas. | journal=Eur Radiol | year= 2016 | volume= 26 | issue= 4 | pages= 1204-12 | pmid=26188658 | doi=10.1007/s00330-015-3907-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26188658  }} </ref><ref name="pmid9016241">{{cite journal| author=Zanetti M, Ledermann T, Zollinger H, Hodler J| title=Efficacy of MR imaging in patients suspected of having Morton's neuroma. | journal=AJR Am J Roentgenol | year= 1997 | volume= 168 | issue= 2 | pages= 529-32 | pmid=9016241 | doi=10.2214/ajr.168.2.9016241 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9016241  }} </ref><ref name="pmid9022580">{{cite journal| author=Williams JW, Meaney J, Whitehouse GH, Klenerman L, Hussein Z| title=MRI in the investigation of Morton's neuroma: which sequences? | journal=Clin Radiol | year= 1997 | volume= 52 | issue= 1 | pages= 46-9 | pmid=9022580 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9022580  }} </ref><ref name="pmid1619223">{{cite journal| author=Unger HR, Mattoso PQ, Drusen MJ, Neumann CH| title=Gadopentetate-enhanced magnetic resonance imaging with fat saturation in the evaluation of Morton's neuroma. | journal=J Foot Surg | year= 1992 | volume= 31 | issue= 3 | pages= 244-6 | pmid=1619223 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1619223  }} </ref><ref name="pmid17420632">{{cite journal| author=Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee JW et al.| title=Morton neuroma: evaluated with ultrasonography and MR imaging. | journal=Korean J Radiol | year= 2007 | volume= 8 | issue= 2 | pages= 148-55 | pmid=17420632 | doi=10.3348/kjr.2007.8.2.148 | pmc=2626779 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17420632  }} </ref><ref name="pmid12601213">{{cite journal| author=Weishaupt D, Treiber K, Kundert HP, Zollinger H, Vienne P, Hodler J et al.| title=Morton neuroma: MR imaging in prone, supine, and upright weight-bearing body positions. | journal=Radiology | year= 2003 | volume= 226 | issue= 3 | pages= 849-56 | pmid=12601213 | doi=10.1148/radiol.2263011925 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12601213  }} </ref><ref name="pmid22719120">{{cite journal| author=Torres-Claramunt R, Ginés A, Pidemunt G, Puig L, de Zabala S| title=MRI and ultrasonography in Morton's neuroma: Diagnostic accuracy and correlation. | journal=Indian J Orthop | year= 2012 | volume= 46 | issue= 3 | pages= 321-5 | pmid=22719120 | doi=10.4103/0019-5413.96390 | pmc=3377144 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22719120  }} </ref><ref name="pmid10954445">{{cite journal| author=Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E| title=Morton's neuroma: is it always symptomatic? | journal=AJR Am J Roentgenol | year= 2000 | volume= 175 | issue= 3 | pages= 649-53 | pmid=10954445 | doi=10.2214/ajr.175.3.1750649 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10954445  }} </ref><ref name="pmid12112506">{{cite journal| author=Weishaupt D, Treiber K, Jacob HA, Kundert HP, Hodler J, Marincek B et al.| title=MR imaging of the forefoot under weight-bearing conditions: position-related changes of the neurovascular bundles and the metatarsal heads in asymptomatic volunteers. | journal=J Magn Reson Imaging | year= 2002 | volume= 16 | issue= 1 | pages= 75-84 | pmid=12112506 | doi=10.1002/jmri.10130 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12112506  }} </ref><ref name="pmid18195378">{{cite journal| author=Studler U, Mengiardi B, Bode B, Schöttle PB, Pfirrmann CW, Hodler J et al.| title=Fibrosis and adventitious bursae in plantar fat pad of forefoot: MR imaging findings in asymptomatic volunteers and MR imaging-histologic comparison. | journal=Radiology | year= 2008 | volume= 246 | issue= 3 | pages= 863-70 | pmid=18195378 | doi=10.1148/radiol.2463070196 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18195378  }} </ref><ref name="pmid10954445">{{cite journal| author=Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E| title=Morton's neuroma: is it always symptomatic? | journal=AJR Am J Roentgenol | year= 2000 | volume= 175 | issue= 3 | pages= 649-53 | pmid=10954445 | doi=10.2214/ajr.175.3.1750649 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10954445  }} </ref>
**Dumbbell/ovoid-shaped lesion at a similar position to that described on ultrasound
**Dumbbell/[[ovoid]]-[[Shape parameter|shaped]] [[lesion]] at a [[Similarity matrix|similar]] [[Position effect|position]] to that described on [[ultrasound]]
**T1: typically low-to-iso signal  
**[[T1]]: typically low-to-iso [[Signal (biology)|signal]]
**T2: typically low signal but can sometimes be intermediate in signal
**T2: typically low [[Signal (biology)|signal]] but can sometimes be intermediate in [[Signal (biology)|signal]]
**T1 C+ (Gd): tends to show intense enhancement
**[[T1]] C+ (Gd): tends to show intense [[Enhancer|enhancement]]
*On MRI, characteristic findings of traumatic neuroma include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*On [[Magnetic resonance imaging|MRI]], [[Characteristic impedance|characteristic]] findings of [[Trauma|traumatic]] neuroma include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
**Fusiform swelling of a nerve or a bulbous mass at a nerve end
**[[Fusiform]] [[swelling]] of a [[nerve]] or a [[Bulbar|bulbous]] [[mass]] at a [[nerve]] [[End-group|end]]
**The parent nerve of some small nerve may difficult or impossible to discern
**The [[Parenting|parent]] [[nerve]] of some small [[nerve]] may difficult or impossible to discern
**T2/STIR:inhomogeneous hyperintensity (may have a hypointense rim)
**T2/STIR: inhomogeneous hyperintensity (may have a hypointense [[Rim Example|rim]])
**T1 C+ (Gd): variable contrast enhancement
**[[T1]] C+ (Gd): [[variable]] [[contrast]] [[Enhancer|enhancement]]
 
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====Ultrasound====
====Ultrasound====
*Ultrasound can help distinguish neuroma from:<ref name="pmid22659760">{{cite journal| author=Fazal MA, Khan I, Thomas C| title=Ultrasonography and magnetic resonance imaging in the diagnosis of Morton's neuroma. | journal=J Am Podiatr Med Assoc | year= 2012 | volume= 102 | issue= 3 | pages= 184-6 | pmid=22659760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22659760  }} </ref><ref name="pmid22325999">{{cite journal| author=Pastides P, El-Sallakh S, Charalambides C| title=Morton's neuroma: A clinical versus radiological diagnosis. | journal=Foot Ankle Surg | year= 2012 | volume= 18 | issue= 1 | pages= 22-4 | pmid=22325999 | doi=10.1016/j.fas.2011.01.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22325999  }} </ref><ref name="pmid14516035">{{cite journal| author=Sharp RJ, Wade CM, Hennessy MS, Saxby TS| title=The role of MRI and ultrasound imaging in Morton's neuroma and the effect of size of lesion on symptoms. | journal=J Bone Joint Surg Br | year= 2003 | volume= 85 | issue= 7 | pages= 999-1005 | pmid=14516035 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14516035  }} </ref>
*[[Ultrasound]] can [[Help Menu|help]] distinguish neuroma from:<ref name="pmid22659760">{{cite journal| author=Fazal MA, Khan I, Thomas C| title=Ultrasonography and magnetic resonance imaging in the diagnosis of Morton's neuroma. | journal=J Am Podiatr Med Assoc | year= 2012 | volume= 102 | issue= 3 | pages= 184-6 | pmid=22659760 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22659760  }} </ref><ref name="pmid22325999">{{cite journal| author=Pastides P, El-Sallakh S, Charalambides C| title=Morton's neuroma: A clinical versus radiological diagnosis. | journal=Foot Ankle Surg | year= 2012 | volume= 18 | issue= 1 | pages= 22-4 | pmid=22325999 | doi=10.1016/j.fas.2011.01.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22325999  }} </ref><ref name="pmid14516035">{{cite journal| author=Sharp RJ, Wade CM, Hennessy MS, Saxby TS| title=The role of MRI and ultrasound imaging in Morton's neuroma and the effect of size of lesion on symptoms. | journal=J Bone Joint Surg Br | year= 2003 | volume= 85 | issue= 7 | pages= 999-1005 | pmid=14516035 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14516035  }} </ref>
**Intermetatarsal bursal swelling or  
**[[Intermetatarsal]] [[Bursa (anatomy)|bursal]] [[swelling]] or
**Synovitis in adjacent joints
**[[Synovitis]] in adjacent [[Joints (anatomy)|joints]]
*On ultrasound, neuroma is characterized by the following findings:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="pmid26571458">{{cite journal| author=Coraci D, Pazzaglia C, Doneddu PE, Erra C, Paolasso I, Santilli V et al.| title=Post-traumatic neuroma due to closed nerve injury. Is recovery after peripheral nerve trauma related to ultrasonographic neuroma size? | journal=Clin Neurol Neurosurg | year= 2015 | volume= 139 | issue=  | pages= 314-8 | pmid=26571458 | doi=10.1016/j.clineuro.2015.10.034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26571458  }} </ref><ref name="pmid10845513">{{cite journal| author=Quinn TJ, Jacobson JA, Craig JG, van Holsbeeck MT| title=Sonography of Morton's neuromas. | journal=AJR Am J Roentgenol | year= 2000 | volume= 174 | issue= 6 | pages= 1723-8 | pmid=10845513 | doi=10.2214/ajr.174.6.1741723 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10845513  }} </ref><ref name="pmid1469213">{{cite journal| author=Pollak RA, Bellacosa RA, Dornbluth NC, Strash WW, Devall JM| title=Sonographic analysis of Morton's neuroma. | journal=J Foot Surg | year= 1992 | volume= 31 | issue= 6 | pages= 534-7 | pmid=1469213 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1469213  }} </ref><ref name="pmid11218988">{{cite journal| author=Tobajas Asensio E, Tobajas Asensio JA, Boada Apilluelo E, Torres Nuez J| title=[Echography evaluation of Morton's neuroma]. | journal=An Med Interna | year= 2000 | volume= 17 | issue= 8 | pages= 416-8 | pmid=11218988 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11218988  }} </ref><ref name="pmid8574369">{{cite journal| author=Shapiro PP, Shapiro SL| title=Sonographic evaluation of interdigital neuromas. | journal=Foot Ankle Int | year= 1995 | volume= 16 | issue= 10 | pages= 604-6 | pmid=8574369 | doi=10.1177/107110079501601003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8574369  }} </ref><ref name="pmid9356915">{{cite journal| author=Sobiesk GA, Wertheimer SJ, Schulz R, Dalfovo M| title=Sonographic evaluation of interdigital neuromas. | journal=J Foot Ankle Surg | year= 1997 | volume= 36 | issue= 5 | pages= 364-6 | pmid=9356915 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9356915  }} </ref><ref name="pmid9498579">{{cite journal| author=Levine SE, Myerson MS, Shapiro PP, Shapiro SL| title=Ultrasonographic diagnosis of recurrence after excision of an interdigital neuroma. | journal=Foot Ankle Int | year= 1998 | volume= 19 | issue= 2 | pages= 79-84 | pmid=9498579 | doi=10.1177/107110079801900205 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9498579  }} </ref><ref name="pmid17586431">{{cite journal| author=Kankanala G, Jain AS| title=The operational characteristics of ultrasonography for the diagnosis of plantar intermetatarsal neuroma. | journal=J Foot Ankle Surg | year= 2007 | volume= 46 | issue= 4 | pages= 213-7 | pmid=17586431 | doi=10.1053/j.jfas.2007.04.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17586431  }} </ref><ref name="pmid10195292">{{cite journal| author=Read JW, Noakes JB, Kerr D, Crichton KJ, Slater HK, Bonar F| title=Morton's metatarsalgia: sonographic findings and correlated histopathology. | journal=Foot Ankle Int | year= 1999 | volume= 20 | issue= 3 | pages= 153-61 | pmid=10195292 | doi=10.1177/107110079902000303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10195292  }} </ref><ref name="pmid17021692">{{cite journal| author=Perini L, Del Borrello M, Cipriano R, Cavallo A, Volpe A| title=Dynamic sonography of the forefoot in Morton's syndrome: correlation with magnetic resonance and surgery. | journal=Radiol Med | year= 2006 | volume= 111 | issue= 7 | pages= 897-905 | pmid=17021692 | doi=10.1007/s11547-006-0088-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17021692  }} </ref>
*On [[ultrasound]], neuroma is [[Characterization (mathematics)|characterized]] by the following findings:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="pmid26571458">{{cite journal| author=Coraci D, Pazzaglia C, Doneddu PE, Erra C, Paolasso I, Santilli V et al.| title=Post-traumatic neuroma due to closed nerve injury. Is recovery after peripheral nerve trauma related to ultrasonographic neuroma size? | journal=Clin Neurol Neurosurg | year= 2015 | volume= 139 | issue=  | pages= 314-8 | pmid=26571458 | doi=10.1016/j.clineuro.2015.10.034 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26571458  }} </ref><ref name="pmid10845513">{{cite journal| author=Quinn TJ, Jacobson JA, Craig JG, van Holsbeeck MT| title=Sonography of Morton's neuromas. | journal=AJR Am J Roentgenol | year= 2000 | volume= 174 | issue= 6 | pages= 1723-8 | pmid=10845513 | doi=10.2214/ajr.174.6.1741723 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10845513  }} </ref><ref name="pmid1469213">{{cite journal| author=Pollak RA, Bellacosa RA, Dornbluth NC, Strash WW, Devall JM| title=Sonographic analysis of Morton's neuroma. | journal=J Foot Surg | year= 1992 | volume= 31 | issue= 6 | pages= 534-7 | pmid=1469213 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1469213  }} </ref><ref name="pmid11218988">{{cite journal| author=Tobajas Asensio E, Tobajas Asensio JA, Boada Apilluelo E, Torres Nuez J| title=[Echography evaluation of Morton's neuroma]. | journal=An Med Interna | year= 2000 | volume= 17 | issue= 8 | pages= 416-8 | pmid=11218988 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11218988  }} </ref><ref name="pmid8574369">{{cite journal| author=Shapiro PP, Shapiro SL| title=Sonographic evaluation of interdigital neuromas. | journal=Foot Ankle Int | year= 1995 | volume= 16 | issue= 10 | pages= 604-6 | pmid=8574369 | doi=10.1177/107110079501601003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8574369  }} </ref><ref name="pmid9356915">{{cite journal| author=Sobiesk GA, Wertheimer SJ, Schulz R, Dalfovo M| title=Sonographic evaluation of interdigital neuromas. | journal=J Foot Ankle Surg | year= 1997 | volume= 36 | issue= 5 | pages= 364-6 | pmid=9356915 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9356915  }} </ref><ref name="pmid9498579">{{cite journal| author=Levine SE, Myerson MS, Shapiro PP, Shapiro SL| title=Ultrasonographic diagnosis of recurrence after excision of an interdigital neuroma. | journal=Foot Ankle Int | year= 1998 | volume= 19 | issue= 2 | pages= 79-84 | pmid=9498579 | doi=10.1177/107110079801900205 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9498579  }} </ref><ref name="pmid17586431">{{cite journal| author=Kankanala G, Jain AS| title=The operational characteristics of ultrasonography for the diagnosis of plantar intermetatarsal neuroma. | journal=J Foot Ankle Surg | year= 2007 | volume= 46 | issue= 4 | pages= 213-7 | pmid=17586431 | doi=10.1053/j.jfas.2007.04.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17586431  }} </ref><ref name="pmid10195292">{{cite journal| author=Read JW, Noakes JB, Kerr D, Crichton KJ, Slater HK, Bonar F| title=Morton's metatarsalgia: sonographic findings and correlated histopathology. | journal=Foot Ankle Int | year= 1999 | volume= 20 | issue= 3 | pages= 153-61 | pmid=10195292 | doi=10.1177/107110079902000303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10195292  }} </ref><ref name="pmid17021692">{{cite journal| author=Perini L, Del Borrello M, Cipriano R, Cavallo A, Volpe A| title=Dynamic sonography of the forefoot in Morton's syndrome: correlation with magnetic resonance and surgery. | journal=Radiol Med | year= 2006 | volume= 111 | issue= 7 | pages= 897-905 | pmid=17021692 | doi=10.1007/s11547-006-0088-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17021692  }} </ref>
**Round to ovoid
**Round to [[ovoid]]
**Well-defined, hypoechoic lesion  
**[[WellPoint|Well]]-defined, hypoechoic [[lesion]]
**Located in the intermetatarsal space proximal to the metatarsal head
**[[Location parameter|Located]] in the [[intermetatarsal]] [[Spacetime|space]] [[proximal]] to the [[metatarsal]] [[head]]
*On ultrasound, traumatic neuroma is characterized by the following findings:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*On [[ultrasound]], [[Trauma|traumatic]] neuroma is [[Characterization (mathematics)|characterized]] by the following findings:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
**Swollen nerve (mass-like)
**[[Swelling|Swollen]] [[nerve]] ([[mass]]-like)
**Hypoechoic
**Hypoechoic
**Loss of normal fibrillar pattern
**[[Loss function|Loss]] of normal [[Fibrillarin|fibrillar]] [[pattern]]
**Usually small, but may be as large as 5 cm
**Usually small, but may be as [[Large-print|large]] as 5 cm


== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*Medical therapy for neuroma may include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
====Conservative therapy for Morton's neuroma====
**[[Tricyclic antidepressant|Tricyclic antidepressants]]  
*[[Morton's neuroma]] should be [[Managed care|managed]] conservatively before proceeding to expensive [[diagnostic procedures]]
**Anticonvulsants (more effective)  
*Conservative [[Measure (mathematics)|measures]] for [[pain relief]] include:<ref name="pmid17147793">{{cite journal| author=Kang JH, Chen MD, Chen SC, Hsi WL| title=Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study. | journal=BMC Musculoskelet Disord | year= 2006 | volume= 7 | issue= | pages= 95 | pmid=17147793 | doi=10.1186/1471-2474-7-95 | pmc=1712337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17147793 }} </ref><ref name="pmid17144963">{{cite journal| author=Jannink M, van Dijk H, Ijzerman M, Groothuis-Oudshoorn K, Groothoff J, Lankhurst G| title=Effectiveness of custom-made orthopaedic shoes in the reduction of foot pain and pressure in patients with degenerative disorders of the foot. | journal=Foot Ankle Int | year= 2006 | volume= 27 | issue= 11 | pages= 974-9 | pmid=17144963 | doi=10.1177/107110070602701119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17144963 }} </ref><ref name="pmid15973088">{{cite journal| author=Hsi WL, Kang JH, Lee XX| title=Optimum position of metatarsal pad in metatarsalgia for pressure relief. | journal=Am J Phys Med Rehabil | year= 2005 | volume= 84 | issue= 7 | pages= 514-20 | pmid=15973088 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15973088 }} </ref><ref name="pmid15153584">{{cite journal| author=Jackson L, Binning J, Potter J| title=Plantar pressures in rheumatoid arthritis using prefabricated metatarsal padding. | journal=J Am Podiatr Med Assoc | year= 2004 | volume= 94 | issue= 3 | pages= 239-45 | pmid=15153584 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15153584 }} </ref><ref name="pmid7894637">{{cite journal| author=Chang AH, Abu-Faraj ZU, Harris GF, Nery J, Shereff MJ| title=Multistep measurement of plantar pressure alterations using metatarsal pads. | journal=Foot Ankle Int | year= 1994 | volume= 15 | issue= 12 | pages= 654-60 | pmid=7894637 | doi=10.1177/107110079401501205 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7894637 }} </ref><ref name="pmid2074081">{{cite journal| author=Holmes GB, Timmerman L| title=A quantitative assessment of the effect of metatarsal pads on plantar pressures. | journal=Foot Ankle | year= 1990 | volume= 11 | issue= 3 | pages= 141-5 | pmid=2074081 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2074081 }} </ref>
**Serotonin-norepinephrine reuptake inhibitors
**Decreasing [[pressure]] on the [[metatarsal]] [[Head|heads]] by [[Usage analysis|using]]:
**Ultrasound-guided interdigital injection of steroid and [[local anaesthetic]] via '''dorsal approach''' into the site of tenderness<ref name="pmid30208078">{{cite journal| author=Malessy MJA, de Boer R, Muñoz Romero I, Eekhof JLA, van Zwet EW, Kliot M et al.| title=Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered. | journal=PLoS One | year= 2018 | volume= 13 | issue= 9 | pages= e0203345 | pmid=30208078 | doi=10.1371/journal.pone.0203345 | pmc=6135496 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30208078 }} </ref><ref name="pmid23740337">{{cite journal| author=Climent JM, Mondéjar-Gómez F, Rodríguez-Ruiz C, Díaz-Llopis I, Gómez-Gallego D, Martín-Medina P| title=Treatment of Morton neuroma with botulinum toxin A: a pilot study. | journal=Clin Drug Investig | year= 2013 | volume= 33 | issue= 7 | pages= 497-503 | pmid=23740337 | doi=10.1007/s40261-013-0090-0 | pmc=3691490 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23740337 }} </ref><ref name="pmid23636185">{{cite journal| author=Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D et al.| title=Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. | journal=J Bone Joint Surg Am | year= 2013 | volume= 95 | issue= 9 | pages= 790-8, S1 | pmid=23636185 | doi=10.2106/JBJS.I.01780 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23636185 }} </ref><ref name="pmid24553891">{{cite journal| author=Schon L| title=An injection of corticosteroid plus anesthetic was more effective than anesthetic alone for Morton neuroma. | journal=J Bone Joint Surg Am | year= 2014 | volume= 96 | issue= 4 | pages= 334 | pmid=24553891 | doi=10.2106/JBJS.9604.ebo028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24553891 }} </ref><ref name="pmid23636203">{{cite journal| author=Smith RW| title=Steroid injection for Morton neuroma - data-based justification. | journal=J Bone Joint Surg Am | year= 2013 | volume= 95 | issue= 9 | pages= e64 | pmid=23636203 | doi=10.2106/JBJS.M.00172 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23636203 }} </ref><ref name="pmid16733414">{{cite journal| author=Haddad-Zebouni S, Elia D, Aoun N, Okais J, Ghossain M| title=[Regression of Morton neuroma after local injection of steroids]. | journal=J Radiol | year= 2006 | volume= 87 | issue= 5 | pages= 566-8 | pmid=16733414 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16733414 }} </ref><ref name="pmid10340428">{{cite journal| author=Basadonna PT, Rucco V, Gasparini D, Onorato A| title=Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report. | journal=Am J Phys Med Rehabil | year= 1999 | volume= 78 | issue= 3 | pages= 283-5 | pmid=10340428 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10340428  }} </ref><ref name="pmid7671475">{{cite journal| author=Reddy PD, Zelicof SB, Ruotolo C, Holder J| title=Interdigital neuroma. Local cutaneous changes after corticosteroid injection. | journal=Clin Orthop Relat Res | year= 1995 | volume=  | issue= 317 | pages= 185-7 | pmid=7671475 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671475  }} </ref><ref name="pmid27301735">{{cite journal| author=van Vendeloo SN, Ettema HB| title=Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma. | journal=Foot Ankle Surg | year= 2016 | volume= 22 | issue= 2 | pages= 139-41 | pmid=27301735 | doi=10.1016/j.fas.2016.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27301735  }} </ref><ref name="pmid29230531">{{cite journal| author=Park YH, Lee JW, Choi GW, Kim HJ| title=Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton's neuroma. | journal=Int Orthop | year= 2018 | volume= 42 | issue= 2 | pages= 323-329 | pmid=29230531 | doi=10.1007/s00264-017-3707-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29230531  }} </ref><ref name="pmid26869493">{{cite journal| author=Mahadevan D, Salmasi M, Whybra N, Nanda A, Gaba S, Mangwani J| title=What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma? | journal=Foot Ankle Surg | year= 2016 | volume= 22 | issue= 1 | pages= 9-11 | pmid=26869493 | doi=10.1016/j.fas.2015.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26869493 }} </ref><ref name="pmid27037432">{{cite journal| author=Mahadevan D, Attwal M, Bhatt R, Bhatia M| title=Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial. | journal=Bone Joint J | year= 2016 | volume= 98-B | issue= 4 | pages= 498-503 | pmid=27037432 | doi=10.1302/0301-620X.98B4.36880 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27037432 }} </ref><ref name="pmid22585530">{{cite journal| author=Yap LP, McNally E| title=Patient's assessment of discomfort during ultrasound-guided injection of Morton's neuroma: selecting the optimal approach. | journal=J Clin Ultrasound | year= 2012 | volume= 40 | issue= 6 | pages= 330-4 | pmid=22585530 | doi=10.1002/jcu.21926 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22585530 }} </ref><ref name="pmid17515373">{{cite journal| author=Hughes RJ, Ali K, Jones H, Kendall S, Connell DA| title=Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 | pages= 1535-9 | pmid=17515373 | doi=10.2214/AJR.06.1463 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515373 }} </ref><ref name="pmid8722878">{{cite journal| author=Wu KK| title=Morton's interdigital neuroma: a clinical review of its etiology, treatment, and results. | journal=J Foot Ankle Surg | year= 1996 | volume= 35 | issue= 2 | pages= 112-9; discussion 187-8 | pmid=8722878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8722878 }} </ref><ref name="pmid8620640">{{cite journal| author=Rasmussen MR, Kitaoka HB, Patzer GL| title=Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. | journal=Clin Orthop Relat Res | year= 1996 | volume= | issue= 326 | pages= 188-93 | pmid=8620640 | doi=10.1097/00003086-199605000-00022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8620640 }} </ref><ref name="pmid18510900">{{cite journal| author=Markovic M, Crichton K, Read JW, Lam P, Slater HK| title=Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. | journal=Foot Ankle Int | year= 2008 | volume= 29 | issue= 5 | pages= 483-7 | pmid=18510900 | doi=10.3113/FAI.2008.0483 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18510900 }} </ref><ref name="pmid18751769">{{cite journal| author=Sofka CM, Adler RS, Ciavarra GA, Pavlov H| title=Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection--preliminary results. | journal=HSS J | year= 2007 | volume= 3 | issue= 1 | pages= 44-9 | pmid=18751769 | doi=10.1007/s11420-006-9029-9 | pmc=2504098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18751769 }} </ref><ref name="pmid17515235">{{cite journal| author=Hassouna H, Singh D, Taylor H, Johnson S| title=Ultrasound guided steroid injection in the treatment of interdigital neuralgia. | journal=Acta Orthop Belg | year= 2007 | volume= 73 | issue= 2 | pages= 224-9 | pmid=17515235 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515235 }} </ref>
***[[Metatarsal]] [[support]]
====Conservative therapy for Morton neuroma====
***[[Metatarsal]] [[bars]]
*Morton neuroma should be managed conservatively before proceeding to expensive diagnostic procedures
***Padding techniques (it's important to [[Place theory (hearing)|place]] [[Insert|inserts]] properly just [[proximal]] to the [[metatarsal]] [[head]]), such as:
*Conservative measures for pain relief include:<ref name="pmid17147793">{{cite journal| author=Kang JH, Chen MD, Chen SC, Hsi WL| title=Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study. | journal=BMC Musculoskelet Disord | year= 2006 | volume= 7 | issue| pages= 95 | pmid=17147793 | doi=10.1186/1471-2474-7-95 | pmc=1712337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17147793  }} </ref><ref name="pmid17144963">{{cite journal| author=Jannink M, van Dijk H, Ijzerman M, Groothuis-Oudshoorn K, Groothoff J, Lankhurst G| title=Effectiveness of custom-made orthopaedic shoes in the reduction of foot pain and pressure in patients with degenerative disorders of the foot. | journal=Foot Ankle Int | year= 2006 | volume= 27 | issue= 11 | pages= 974-9 | pmid=17144963 | doi=10.1177/107110070602701119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17144963 }} </ref><ref name="pmid15973088">{{cite journal| author=Hsi WL, Kang JH, Lee XX| title=Optimum position of metatarsal pad in metatarsalgia for pressure relief. | journal=Am J Phys Med Rehabil | year= 2005 | volume= 84 | issue= 7 | pages= 514-20 | pmid=15973088 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15973088 }} </ref><ref name="pmid15153584">{{cite journal| author=Jackson L, Binning J, Potter J| title=Plantar pressures in rheumatoid arthritis using prefabricated metatarsal padding. | journal=J Am Podiatr Med Assoc | year= 2004 | volume= 94 | issue= 3 | pages= 239-45 | pmid=15153584 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15153584 }} </ref><ref name="pmid7894637">{{cite journal| author=Chang AH, Abu-Faraj ZU, Harris GF, Nery J, Shereff MJ| title=Multistep measurement of plantar pressure alterations using metatarsal pads. | journal=Foot Ankle Int | year= 1994 | volume= 15 | issue= 12 | pages= 654-60 | pmid=7894637 | doi=10.1177/107110079401501205 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7894637 }} </ref><ref name="pmid2074081">{{cite journal| author=Holmes GB, Timmerman L| title=A quantitative assessment of the effect of metatarsal pads on plantar pressures. | journal=Foot Ankle | year= 1990 | volume= 11 | issue= 3 | pages= 141-5 | pmid=2074081 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2074081 }} </ref>
****[[Metatarsal]] pads
**Decreasing pressure on the metatarsal heads by using:
****[[Toe]] [[Crestor|crest]] pads
***Metatarsal support
***[[Tapping AFM|Tapping]] the [[toe]] [[area]]
***Metatarsal bars
***[[Shoe insert|Shoe inserts]] ([[orthotics]]) [[Help Menu|help]] in [[Corrective|correcting]] any [[Mechanical energy|mechanical]] [[imbalance]] in the [[foot]]
***Metatarsal pads
***[[Specialize|Specialized]] [[orthopedic]] [[Shoe insert|shoes]]
***Padded shoe insert (it's important to place inserts properly just proximal to the metatarsal head)
***Comfortable [[Shoe insert|shoes]] (with the [[Help desk|help]] of a [[Professional courtesy|professional]] [[Shoe insert|shoe]] fitting device) having:
***Orthotics
****[[Wide and fast|Wider]] [[toe]] [[box]] allowing [[Spreading activation|spread]] of [[metatarsal]] [[Head|heads]]
***Specialized orthopedic shoes
**** Low [[Heel|heels]]
***Broad-toed shoe allowing spread of metatarsal heads
**** Good [[arch support]]
***Determine proper shoe width while standing with the help of a professional shoe fitting device
**[[Physical therapy]]
**Strength exercises for intrinsic foot muscles
**[[Ice]] [[massage]]
**[[Strength training|Strength]] [[exercises]] for [[Intrinsic bioremediation|intrinsic]] [[foot]] [[muscles]]
**[[Rest cure|Resting]]
 
====Non-conservative medical therapy====
*When conservative [[Measurement|measures]] [[Failure|fail]], following [[Medical therapy template|medical therapy]] is [[Usage analysis|used]] for non-[[Surgery|surgical]] [[Treatments|treatment]] of neuroma:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
**[[Tricyclic antidepressant|Tricyclic antidepressants]]
**[[Anticonvulsants]] (more [[Effective method|effective]])
**[[Serotonin-norepinephrine reuptake inhibitor|Serotonin-norepinephrine reuptake inhibitors]]
**[[Ultrasound]]-[[Guidant|guided]] [[Intermetatarsal|interdigital]] [[Injection (medicine)|injection]] of following [[Nerve block|nerve blocking]] [[Agent architecture|agents]] via '''[[dorsal]] approach''' into the [[Site Master File|site]] of [[tenderness]]:<ref name="pmid30208078">{{cite journal| author=Malessy MJA, de Boer R, Muñoz Romero I, Eekhof JLA, van Zwet EW, Kliot M et al.| title=Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered. | journal=PLoS One | year= 2018 | volume= 13 | issue= 9 | pages= e0203345 | pmid=30208078 | doi=10.1371/journal.pone.0203345 | pmc=6135496 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30208078 }} </ref><ref name="pmid23740337">{{cite journal| author=Climent JM, Mondéjar-Gómez F, Rodríguez-Ruiz C, Díaz-Llopis I, Gómez-Gallego D, Martín-Medina P| title=Treatment of Morton neuroma with botulinum toxin A: a pilot study. | journal=Clin Drug Investig | year= 2013 | volume= 33 | issue= 7 | pages= 497-503 | pmid=23740337 | doi=10.1007/s40261-013-0090-0 | pmc=3691490 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23740337 }} </ref><ref name="pmid23636185">{{cite journal| author=Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D et al.| title=Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. | journal=J Bone Joint Surg Am | year= 2013 | volume= 95 | issue= 9 | pages= 790-8, S1 | pmid=23636185 | doi=10.2106/JBJS.I.01780 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23636185 }} </ref><ref name="pmid24553891">{{cite journal| author=Schon L| title=An injection of corticosteroid plus anesthetic was more effective than anesthetic alone for Morton neuroma. | journal=J Bone Joint Surg Am | year= 2014 | volume= 96 | issue= 4 | pages= 334 | pmid=24553891 | doi=10.2106/JBJS.9604.ebo028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24553891 }} </ref><ref name="pmid23636203">{{cite journal| author=Smith RW| title=Steroid injection for Morton neuroma - data-based justification. | journal=J Bone Joint Surg Am | year= 2013 | volume= 95 | issue= 9 | pages= e64 | pmid=23636203 | doi=10.2106/JBJS.M.00172 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23636203 }} </ref><ref name="pmid16733414">{{cite journal| author=Haddad-Zebouni S, Elia D, Aoun N, Okais J, Ghossain M| title=[Regression of Morton neuroma after local injection of steroids]. | journal=J Radiol | year= 2006 | volume= 87 | issue= 5 | pages= 566-8 | pmid=16733414 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16733414 }} </ref><ref name="pmid10340428">{{cite journal| author=Basadonna PT, Rucco V, Gasparini D, Onorato A| title=Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report. | journal=Am J Phys Med Rehabil | year= 1999 | volume= 78 | issue= 3 | pages= 283-5 | pmid=10340428 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10340428 }} </ref><ref name="pmid7671475">{{cite journal| author=Reddy PD, Zelicof SB, Ruotolo C, Holder J| title=Interdigital neuroma. Local cutaneous changes after corticosteroid injection. | journal=Clin Orthop Relat Res | year= 1995 | volume= | issue= 317 | pages= 185-7 | pmid=7671475 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7671475 }} </ref><ref name="pmid27301735">{{cite journal| author=van Vendeloo SN, Ettema HB| title=Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma. | journal=Foot Ankle Surg | year= 2016 | volume= 22 | issue= 2 | pages= 139-41 | pmid=27301735 | doi=10.1016/j.fas.2016.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27301735 }} </ref><ref name="pmid29230531">{{cite journal| author=Park YH, Lee JW, Choi GW, Kim HJ| title=Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton's neuroma. | journal=Int Orthop | year= 2018 | volume= 42 | issue= 2 | pages= 323-329 | pmid=29230531 | doi=10.1007/s00264-017-3707-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29230531 }} </ref><ref name="pmid26869493">{{cite journal| author=Mahadevan D, Salmasi M, Whybra N, Nanda A, Gaba S, Mangwani J| title=What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma? | journal=Foot Ankle Surg | year= 2016 | volume= 22 | issue= 1 | pages= 9-11 | pmid=26869493 | doi=10.1016/j.fas.2015.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26869493  }} </ref><ref name="pmid27037432">{{cite journal| author=Mahadevan D, Attwal M, Bhatt R, Bhatia M| title=Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial. | journal=Bone Joint J | year= 2016 | volume= 98-B | issue= 4 | pages= 498-503 | pmid=27037432 | doi=10.1302/0301-620X.98B4.36880 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27037432 }} </ref><ref name="pmid22585530">{{cite journal| author=Yap LP, McNally E| title=Patient's assessment of discomfort during ultrasound-guided injection of Morton's neuroma: selecting the optimal approach. | journal=J Clin Ultrasound | year= 2012 | volume= 40 | issue= 6 | pages= 330-4 | pmid=22585530 | doi=10.1002/jcu.21926 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22585530 }} </ref><ref name="pmid17515373">{{cite journal| author=Hughes RJ, Ali K, Jones H, Kendall S, Connell DA| title=Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. | journal=AJR Am J Roentgenol | year= 2007 | volume= 188 | issue= 6 | pages= 1535-9 | pmid=17515373 | doi=10.2214/AJR.06.1463 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515373 }} </ref><ref name="pmid8722878">{{cite journal| author=Wu KK| title=Morton's interdigital neuroma: a clinical review of its etiology, treatment, and results. | journal=J Foot Ankle Surg | year= 1996 | volume= 35 | issue= 2 | pages= 112-9; discussion 187-8 | pmid=8722878 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8722878 }} </ref><ref name="pmid8620640">{{cite journal| author=Rasmussen MR, Kitaoka HB, Patzer GL| title=Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. | journal=Clin Orthop Relat Res | year= 1996 | volume= | issue= 326 | pages= 188-93 | pmid=8620640 | doi=10.1097/00003086-199605000-00022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8620640 }} </ref><ref name="pmid18510900">{{cite journal| author=Markovic M, Crichton K, Read JW, Lam P, Slater HK| title=Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. | journal=Foot Ankle Int | year= 2008 | volume= 29 | issue= 5 | pages= 483-7 | pmid=18510900 | doi=10.3113/FAI.2008.0483 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18510900  }} </ref><ref name="pmid18751769">{{cite journal| author=Sofka CM, Adler RS, Ciavarra GA, Pavlov H| title=Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection--preliminary results. | journal=HSS J | year= 2007 | volume= 3 | issue= 1 | pages= 44-9 | pmid=18751769 | doi=10.1007/s11420-006-9029-9 | pmc=2504098 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18751769  }} </ref><ref name="pmid17515235">{{cite journal| author=Hassouna H, Singh D, Taylor H, Johnson S| title=Ultrasound guided steroid injection in the treatment of interdigital neuralgia. | journal=Acta Orthop Belg | year= 2007 | volume= 73 | issue= 2 | pages= 224-9 | pmid=17515235 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17515235  }} </ref>
***[[Steroid]]
***[[Local anaesthetic]]
**[[Anti-inflammatory drug|Anti-inflammatory drugs]] ([[Orally ingested|orally]] or [[injected]] into the [[toe]] [[area]]), such as:
***[[Ibuprofen]] ([[Advil]], [[Motrin]])
***[[Naproxen]] ([[Naproxen sodium|Aleve]], [[Naprosyne|Naprosyn]])
**[[Painkillers]] (not [[Recommender system|recommended]] for [[Long-term care|long-term]] [[Treatments|treatment]])


=== Surgery ===
=== Surgery ===
*Surgery is the mainstay of therapy for [[neuroma]]<ref name="pmid27340257">{{cite journal| author=Souza JM, Purnell CA, Cheesborough JE, Kelikian AS, Dumanian GA| title=Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts. | journal=Foot Ankle Int | year= 2016 | volume= 37 | issue= 10 | pages= 1098-1105 | pmid=27340257 | doi=10.1177/1071100716655348 | pmc=5363503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27340257  }} </ref><ref name="pmid29685562">{{cite journal| author=Bibbo C, Rodrigues-Colazzo E, Finzen AG| title=Superficial Peroneal Nerve to Deep Peroneal Nerve Transfer With Allograft Conduit for Neuroma in Continuity. | journal=J Foot Ankle Surg | year= 2018 | volume= 57 | issue= 3 | pages= 514-517 | pmid=29685562 | doi=10.1053/j.jfas.2017.11.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29685562  }} </ref><ref name="pmid23447512">{{cite journal| author=Gould JS, Naranje SM, McGwin G, Florence M, Cheppalli S| title=Use of collagen conduits in management of painful neuromas of the foot and ankle. | journal=Foot Ankle Int | year= 2013 | volume= 34 | issue= 7 | pages= 932-40 | pmid=23447512 | doi=10.1177/1071100713478927 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23447512  }} </ref><ref name="pmid26297693">{{cite journal| author=Rungprai C, Cychosz CC, Phruetthiphat O, Femino JE, Amendola A, Phisitkul P| title=Simple Neurectomy Versus Neurectomy With Intramuscular Implantation for Interdigital Neuroma: A Comparative Study. | journal=Foot Ankle Int | year= 2015 | volume= 36 | issue= 12 | pages= 1412-24 | pmid=26297693 | doi=10.1177/1071100715596741 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26297693  }} </ref><ref name="pmid18442581">{{cite journal| author=Williams EH, Williams CG, Rosson GD, Heitmiller RF, Dellon AL| title=Neurectomy for treatment of intercostal neuralgia. | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 5 | pages= 1766-70 | pmid=18442581 | doi=10.1016/j.athoracsur.2007.11.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18442581  }} </ref><ref name="pmid9607662">{{cite journal| author=Sood MK, Elliot D| title=Treatment of painful neuromas of the hand and wrist by relocation into the pronator quadratus muscle. | journal=J Hand Surg Br | year= 1998 | volume= 23 | issue= 2 | pages= 214-9 | pmid=9607662 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9607662  }} </ref><ref name="pmid17126969">{{cite journal| author=Atherton DD, Leong JC, Anand P, Elliot D| title=Relocation of painful end neuromas and scarred nerves from the zone II territory of the hand. | journal=J Hand Surg Eur Vol | year= 2007 | volume= 32 | issue= 1 | pages= 38-44 | pmid=17126969 | doi=10.1016/j.jhsb.2006.10.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17126969  }} </ref><ref name="pmid15234497">{{cite journal| author=Hazari A, Elliot D| title=Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation. | journal=J Hand Surg Br | year= 2004 | volume= 29 | issue= 4 | pages= 338-50 | pmid=15234497 | doi=10.1016/j.jhsb.2004.01.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15234497  }} </ref><ref name="pmid18443055">{{cite journal| author=Atherton DD, Fabre J, Anand P, Elliot D| title=Relocation of painful neuromas in Zone III of the hand and forearm. | journal=J Hand Surg Eur Vol | year= 2008 | volume= 33 | issue= 2 | pages= 155-62 | pmid=18443055 | doi=10.1177/1753193408087107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18443055  }} </ref><ref name="pmid3631861">{{cite journal| author=Mackinnon SE, Dellon AL| title=Results of treatment of recurrent dorsoradial wrist neuromas. | journal=Ann Plast Surg | year= 1987 | volume= 19 | issue= 1 | pages= 54-61 | pmid=3631861 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3631861  }} </ref><ref name="pmid23892930">{{cite journal| author=Park EH, Kim YS, Lee HJ, Koh YG| title=Metatarsal shortening osteotomy for decompression of Morton's neuroma. | journal=Foot Ankle Int | year= 2013 | volume= 34 | issue= 12 | pages= 1654-60 | pmid=23892930 | doi=10.1177/1071100713499905 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23892930  }} </ref><ref name="pmid29047294">{{cite journal| author=Preston N, Peterson D, Allen J, Kawalec JS, Whitaker J| title=Deep Transverse Metatarsal Ligament Transection in Morton's Neuroma Excision: A Cadaveric Study Examining Effects on Metatarsal Alignment. | journal=Foot Ankle Spec | year= 2018 | volume= 11 | issue= 4 | pages= 342-346 | pmid=29047294 | doi=10.1177/1938640017735888 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29047294  }} </ref><ref name="pmid26344448">{{cite journal| author=Kasparek M, Schneider W| title=Transection of the deep metatarsal transverse ligament in Morton's neuroma surgery does not increase risk of splayfoot development. | journal=Int Orthop | year= 2016 | volume= 40 | issue= 5 | pages= 953-7 | pmid=26344448 | doi=10.1007/s00264-015-2981-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26344448  }} </ref><ref name="pmid22134434">{{cite journal| author=Lee KT, Kim JB, Young KW, Park YU, Kim JS, Jegal H| title=Long-term results of neurectomy in the treatment of Morton's neuroma: more than 10 years' follow-up. | journal=Foot Ankle Spec | year= 2011 | volume= 4 | issue= 6 | pages= 349-53 | pmid=22134434 | doi=10.1177/1938640011428510 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22134434  }} </ref>
*[[Surgery|Surgical]] [[excision]] is the [[Treatments|treatment]] of choice for neuroma<ref name="pmid27340257">{{cite journal| author=Souza JM, Purnell CA, Cheesborough JE, Kelikian AS, Dumanian GA| title=Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts. | journal=Foot Ankle Int | year= 2016 | volume= 37 | issue= 10 | pages= 1098-1105 | pmid=27340257 | doi=10.1177/1071100716655348 | pmc=5363503 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27340257  }} </ref><ref name="pmid29685562">{{cite journal| author=Bibbo C, Rodrigues-Colazzo E, Finzen AG| title=Superficial Peroneal Nerve to Deep Peroneal Nerve Transfer With Allograft Conduit for Neuroma in Continuity. | journal=J Foot Ankle Surg | year= 2018 | volume= 57 | issue= 3 | pages= 514-517 | pmid=29685562 | doi=10.1053/j.jfas.2017.11.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29685562  }} </ref><ref name="pmid23447512">{{cite journal| author=Gould JS, Naranje SM, McGwin G, Florence M, Cheppalli S| title=Use of collagen conduits in management of painful neuromas of the foot and ankle. | journal=Foot Ankle Int | year= 2013 | volume= 34 | issue= 7 | pages= 932-40 | pmid=23447512 | doi=10.1177/1071100713478927 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23447512  }} </ref><ref name="pmid26297693">{{cite journal| author=Rungprai C, Cychosz CC, Phruetthiphat O, Femino JE, Amendola A, Phisitkul P| title=Simple Neurectomy Versus Neurectomy With Intramuscular Implantation for Interdigital Neuroma: A Comparative Study. | journal=Foot Ankle Int | year= 2015 | volume= 36 | issue= 12 | pages= 1412-24 | pmid=26297693 | doi=10.1177/1071100715596741 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26297693  }} </ref><ref name="pmid18442581">{{cite journal| author=Williams EH, Williams CG, Rosson GD, Heitmiller RF, Dellon AL| title=Neurectomy for treatment of intercostal neuralgia. | journal=Ann Thorac Surg | year= 2008 | volume= 85 | issue= 5 | pages= 1766-70 | pmid=18442581 | doi=10.1016/j.athoracsur.2007.11.058 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18442581  }} </ref><ref name="pmid9607662">{{cite journal| author=Sood MK, Elliot D| title=Treatment of painful neuromas of the hand and wrist by relocation into the pronator quadratus muscle. | journal=J Hand Surg Br | year= 1998 | volume= 23 | issue= 2 | pages= 214-9 | pmid=9607662 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9607662  }} </ref><ref name="pmid17126969">{{cite journal| author=Atherton DD, Leong JC, Anand P, Elliot D| title=Relocation of painful end neuromas and scarred nerves from the zone II territory of the hand. | journal=J Hand Surg Eur Vol | year= 2007 | volume= 32 | issue= 1 | pages= 38-44 | pmid=17126969 | doi=10.1016/j.jhsb.2006.10.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17126969  }} </ref><ref name="pmid15234497">{{cite journal| author=Hazari A, Elliot D| title=Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation. | journal=J Hand Surg Br | year= 2004 | volume= 29 | issue= 4 | pages= 338-50 | pmid=15234497 | doi=10.1016/j.jhsb.2004.01.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15234497  }} </ref><ref name="pmid18443055">{{cite journal| author=Atherton DD, Fabre J, Anand P, Elliot D| title=Relocation of painful neuromas in Zone III of the hand and forearm. | journal=J Hand Surg Eur Vol | year= 2008 | volume= 33 | issue= 2 | pages= 155-62 | pmid=18443055 | doi=10.1177/1753193408087107 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18443055  }} </ref><ref name="pmid3631861">{{cite journal| author=Mackinnon SE, Dellon AL| title=Results of treatment of recurrent dorsoradial wrist neuromas. | journal=Ann Plast Surg | year= 1987 | volume= 19 | issue= 1 | pages= 54-61 | pmid=3631861 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3631861  }} </ref><ref name="pmid23892930">{{cite journal| author=Park EH, Kim YS, Lee HJ, Koh YG| title=Metatarsal shortening osteotomy for decompression of Morton's neuroma. | journal=Foot Ankle Int | year= 2013 | volume= 34 | issue= 12 | pages= 1654-60 | pmid=23892930 | doi=10.1177/1071100713499905 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23892930  }} </ref><ref name="pmid29047294">{{cite journal| author=Preston N, Peterson D, Allen J, Kawalec JS, Whitaker J| title=Deep Transverse Metatarsal Ligament Transection in Morton's Neuroma Excision: A Cadaveric Study Examining Effects on Metatarsal Alignment. | journal=Foot Ankle Spec | year= 2018 | volume= 11 | issue= 4 | pages= 342-346 | pmid=29047294 | doi=10.1177/1938640017735888 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29047294  }} </ref><ref name="pmid26344448">{{cite journal| author=Kasparek M, Schneider W| title=Transection of the deep metatarsal transverse ligament in Morton's neuroma surgery does not increase risk of splayfoot development. | journal=Int Orthop | year= 2016 | volume= 40 | issue= 5 | pages= 953-7 | pmid=26344448 | doi=10.1007/s00264-015-2981-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26344448  }} </ref><ref name="pmid22134434">{{cite journal| author=Lee KT, Kim JB, Young KW, Park YU, Kim JS, Jegal H| title=Long-term results of neurectomy in the treatment of Morton's neuroma: more than 10 years' follow-up. | journal=Foot Ankle Spec | year= 2011 | volume= 4 | issue= 6 | pages= 349-53 | pmid=22134434 | doi=10.1177/1938640011428510 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22134434  }} </ref>
*Surgical excision is the treatment of choice for patients with neuroma; this surgical intervention is associated with a relatively favorable success rate, approximately 80%
*[[Surgery|Surgical]] [[excision]] is [[Association (statistics)|associated]] with a [[Relatively compact|relatively]] favorable success [[rate]] of approximately 80%
*The recurrence rate after surgery is as high as 50%
*[[Recurrence plot|Recurrence]] [[rate]] [[after surgery]] is as high as 50%


=== Prevention ===
=== Prevention ===
*There are no primary preventive measures available for neuroma<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*There are no [[Primary prevention|primary preventive]] [[Measure (mathematics)|measures]] available for neuroma<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Secondary prevention measures include: personal hygiene measures, such as wearing ergonomic shoes
*[[Secondary prevention]] [[Measure (mathematics)|measures]] include: [[personal hygiene]] [[Measure (mathematics)|measures]], such as [[Wear red day|wearing]] [[ergonomic]] [[Shoe insert|shoes]]
 
==Differential Diagnosis==
*Neuroma must be [[Differentiate|differentiated]] from other [[diseases]] that [[Causes|cause]] [[Foot|forefoot]] [[pain]] and [[numbness]] such as:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
**[[Stress fracture]] ([[neck]] of the [[metatarsal]])
**[[Rheumatoid arthritis]]
**[[Hammer toe]]
**[[Neurofibroma]]
 
{| class="wikitable"
|+Differentiating neuroma from other causes of intermetatarsal pain
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease/Condition}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Underlying Etiology}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Pathophysiology}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Clinical presentation}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Other associated features}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |'''Neuroma'''
|
 
 
Indirect [[nerve]] [[trauma]]
 
* Especially during a [[surgery]]
*[[Cone biopsy]] ([[rare]] [[Complications|complication]])
* 55% of [[hysterectomy]] [[patients]] have microneuromas, [[Association (statistics)|associated]] with [[childbirth]]
*[[Traction (orthopedics)|Traction]] [[injury]]
*[[Chronic (medical)|Chronic]] [[Repetitive stress injury|repetitive stress]][[Improper rotation|Improper]] [[Foot|footwear]]/tight [[Shoe insert|shoes]]
*[[Repetitive stress injury|High-]][[Impacted|impact]] [[Sports medicine|sports]] (e.g., [[Rock climbing|rock-climbing]], ballet dancing, jogging, [[running]], [[snow]] skiing)
*[[Repetitive stress injury|Overpronation]]
|
* [[Neural]] [[degeneration]] with [[Epineurium|epineural]] and [[Endoneurium|endoneural]] [[vascular]] [[Hyaline|hyalinization]], and [[Perineurium|perineural]] [[fibrosis]]
 
* [[fibrosis|G]][[gross pathology|ross pathological]]<nowiki/>findings of neuroma include:
 
**[[fibrosis|Adherent fibrofatty]] [[Tissue (biology)|tissue]]
**[[fibrosis|Small, firm,]] [[oval]], yellowish-white, [[Slow|slowly]] [[Growth|growing]], [[palpable]] [[nodule]] on [[skin]] (no discoloration of [[skin]] on the [[Top7|top]] of [[nodule]])
**[[fibrosis|</=2cm in]] [[Size consistency|size]]
 
*[[fibrosis|M]][[microscopic|icroscopic]] [[histopathological]] [[analysis]] of neuroma shows:
**[[fibrosis|Extensive fibrosis around and within the]] [[nerve]]
**[[fibrosis|Digital]] [[artery]]
**[[fibrosis|Thrombosis]]
**[[fibrosis|Arterial]] [[Thickener|thickening]]
|
*Focal [[area]] of [[Trauma|traumatic]] [[neuropathic]] [[pain]] [[Radiation|radiating]] to [[toes]]:
**Shooting
**[[Burn|Burning]]
**Stabbing
**[[Raw]]
**Gnawing
**[[Sick|Sickening]] [[sensations]]
*[[Numbness]]
*[[Paresthesias|Paresthesia]] over the [[Injured reserve list|injured]] [[area]]
*[[Dysesthesia]] ([[painful]] [[hypersensitivity]] to normal [[light]] [[tactile]] [[Stimulants|stimuli]])
*[[Function (biology)|Functional]] [[impairment]]
*[[Psychological]] [[distress]] (severely decreasing the [[quality of life]])
*[[Local]] [[Tenderness (medicine)|tenderness]]
*[[Limiting factor|Limited]] [[range of motion]]
*[[Mulder's sign]]
*[[Mulder's sign|Difficulty walking]]
*[[Limp|Limping]]
|
*Most common [[oral]] [[Location parameter|locations]] are:
**[[Tongue]]
**Near [[mental foramen]] of [[mouth]]
*[[Rare|Rarely]] involves:
**[[Head]]
**[[Neck]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |'''[[Metatarsal]] [[stress fracture]]''' ([[Neck]] of [[Metatarsal bones|metatarsal bone]])<ref name="pmid17805074">{{cite journal| author=Kelsey JL, Bachrach LK, Procter-Gray E, Nieves J, Greendale GA, Sowers M et al.| title=Risk factors for stress fracture among young female cross-country runners. | journal=Med Sci Sports Exerc | year= 2007 | volume= 39 | issue= 9 | pages= 1457-63 | pmid=17805074 | doi=10.1249/mss.0b013e318074e54b | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17805074  }} </ref>
|[[Repeatability|Repeated]] extraordinary [[Stress (medicine)|stress]], overuse, or [[trauma]] to the [[bone]] [[Causes|caused]] by any of the following:
* Sudden undertake of a [[Bursting|burst]] of [[exercise]] in a [[Sedentary behavior|sedentary]] [[person]]
* Olympic-class [[Athletic training|athletics]] (extraordinary [[Quantitative|quantities]] of high-[[Impact factor|impact]] [[exercise]])
* Long [[Distance matrix|distance]] marches ([[Military medicine|military]][[Recruitment status|recruits]])
* [[Running]] ([[Tracking changes|track]] and [[Field desorption|field]] [[athletes]])
* [[Jumping]]
* [[Sports Medicine|Sports]] such as soccer, tennis, gymnastics & basketball
* [[Muscle]] [[fatigue]]
* Previous [[stress fracture]]
* [[Osteoporosis]] (weakens the [[bone]], [[Causes|causing]] [[stress fracture]] by just normal [[Activity (chemistry)|activity]])
* [[Flat feet]]
* High or rigid [[foot]] [[Archae|arch]]
* [[Lack (manque)|Lack]] of [[nutrients]] due to [[eating disorders]], [[Lack (manque)|lack]] of [[vitamin D]] & [[calcium]]
* [[Menopause]] (or [[Womens Pack|women]] with [[abnormal]][[menstrual cycles]])
|
* Over the [[Time constant|time]], if enough [[Stress (medicine)|stress]]<nowiki/>is [[Place cell|placed]] on the [[bone]][[Repeatability|repetitively]], it [[Exhaustion|exhausts]] the capacity of the [[bone]] to remodel without enough [[Time constant|time]]<nowiki/>for [[recovery]] resorb [[Cells (biology)|cells]] faster than [[Human body|body]] can [[Replacement joint|replace]] them, [[Result|resulting]] in a weakened site [[Causes|causing]] tiny [[Cracking (chemistry)|cracks]] in a [[bone]], or severe [[bruising]] within a [[bone]] [[Lead|leading]] to [[stress fracture]]
|
* [[Local]] [[pain]] (worsens with [[Time constant|time]])
* [[Local]] [[Tenderness (medicine)|tenderness]] (originates from a [[Specific activity|specific]] [[spot]] & decreases during [[Rest cure|rest]])
* [[Swelling]] around the [[painful]] [[area]]
|[[Stress fracture]] can be [[Prevention (medical)|prevented]] by following [[Measurement|measures]]:
* Starting [[new]] [[exercise]] gradually with [[slow]] progression
* [[Usage analysis|Using]] proper [[Foot|footwear]]
* Adding low-[[Impact factor|impact]] [[Activities of daily living|activities]] to the [[exercise]] regimen to avoid putting [[Stress (medicine)|stress]] on a particular [[Human body|body]] part
* [[Strength training|Strengthening]] [[exercises]] for [[Calf muscle|calf]] and [[shin]] [[muscles]] to [[Avoidance response|avoid]] [[muscle fatigue]]
* [[Get involved|Getting]] [[Appropriate Use Criteria|appropriate]] [[nutrition]](especially in [[osteoporosis]] & [[menopause]]) having [[Adequately wet|adequate]][[Amount of substance|amounts]] of:
** [[Vitamin D]]
** [[Calcium]]
** [[Essential nutrients]]
**
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Rheumatoid arthritis|'''Rheumatoid arthritis''']]<ref name="pmid19790122">{{cite journal |vauthors=Barton A, Worthington J |title=Genetic susceptibility to rheumatoid arthritis: an emerging picture |journal=Arthritis Rheum. |volume=61 |issue=10 |pages=1441–6 |date=October 2009 |pmid=19790122 |doi=10.1002/art.24672 |url=}}</ref><ref name="pmid20436074">{{cite journal |vauthors=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 |title=Antibodies to porphyromonas gingivalis are associated with anticitrullinated protein antibodies in patients with rheumatoid arthritis and their relatives |journal=J. Rheumatol. |volume=37 |issue=6 |pages=1105–12 |date=June 2010 |pmid=20436074 |doi=10.3899/jrheum.091323 |url=}}</ref><ref name="pmid21343168">{{cite journal |vauthors=Routsias JG, Goules JD, Goules A, Charalampakis G, Pikazis D |title=Autopathogenic correlation of periodontitis and rheumatoid arthritis |journal=Rheumatology (Oxford) |volume=50 |issue=7 |pages=1189–93 |date=July 2011 |pmid=21343168 |doi=10.1093/rheumatology/ker090 |url=}}</ref><ref name="pmid10366115">{{cite journal |vauthors=Barrett JH, Brennan P, Fiddler M, Silman AJ |title=Does rheumatoid arthritis remit during pregnancy and relapse postpartum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy |journal=Arthritis Rheum. |volume=42 |issue=6 |pages=1219–27 |date=June 1999 |pmid=10366115 |doi=10.1002/1529-0131(199906)42:6<1219::AID-ANR19>3.0.CO;2-G |url=}}</ref><ref name="pmid26435495">{{cite journal |vauthors=Louati K, Berenbaum F |title=Fatigue in chronic inflammation - a link to pain pathways |journal=Arthritis Res. Ther. |volume=17 |issue= |pages=254 |date=October 2015 |pmid=26435495 |pmc=4593220 |doi=10.1186/s13075-015-0784-1 |url=}}</ref><ref name="pmid23335492">{{cite journal |vauthors=Nikolaus S, Bode C, Taal E, van de Laar MA |title=Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review |journal=Arthritis Care Res (Hoboken) |volume=65 |issue=7 |pages=1128–46 |date=July 2013 |pmid=23335492 |doi=10.1002/acr.21949 |url=}}</ref>
|Common [[causes]] include:
* [[Idiopathic]]
* [[Genetic]] ([[HLA-DR4]] [[Cluster (epidemiology)|cluster]], [[HLA-DR1]])
* [[Environmental science|Environmental]] ([[smoking]])
* [[Hormonal]] [[Hyperprolactinemia|(hyperprolactinemia]])
* [[Immunological|Immunologic]]
* [[Infections]] ([[mycoplasma]], [[Epstein Barr virus|epstein-Barr virus]], [[rubella virus]], [[porphyromonas gingivalis]])
* Socioeconomic factors
* [[Psychological]] factors
* [[Lifestyle]] factors ([[obesity]], poor [[health]])
|On [[gross pathology]], following [[Features (pattern recognition)|features]] may be noticed:
* [[Irregular lesion|Irregular]] [[Surface anatomy|surface]], seen due to [[synovial]] [[hyperplasia]]
* Subchondral [[cysts]](usually [[Presenting symptom|present]] at the later stage of [[disease]])
[[Microscopic]] [[histopathological]][[analysis]] shows:
* [[Formation matrix|Formation]] of [[new]] [[synovial]][[Blood vessel|blood vessels]] (earliest finding)
* [[Hypertrophy (medical)|Hypertrophy]] of [[synovial]] [[Line|lining]]<nowiki/>layer
* [[Infiltration (medical)|Infiltration]] of [[mononuclear cells]]
* [[Chronic (medical)|Chronic]] [[inflammation]] with [[lymphocytic]] [[Infiltration (medical)|infiltration]]
* [[Pannus]] [[Formation matrix|formation]](fibrovascular [[Tissue (biology)|tissue]] or [[granulation tissue]])
|Common [[symptoms]] of [[rheumatoid arthritis]] include:
* [[Joint pain]] involving small [[Joints (anatomy)|joints]] of the [[hands]], [[wrist]], and [[foot]]
* [[Joint swelling]]
* [[Morning report (medicine)|Morning]] [[joint stiffness]] classically lasting for more than an hour
* Decreased [[Grippe|grip]] [[Strength training|strength]]
* [[Generalization|Generalized]] [[aching]]
* [[Fatigue]]
* [[Weight loss]]
* [[Depression]]
* Less commonly, involvement of [[cervical spine]] leads to [[neurological]][[symptoms]] such as:
** [[Tingling]] in the [[arm]]
** [[Numbness]] in the [[arm]]
** [[Weakness]] in the [[arm]]
|[[Condition|Conditions]] [[Association (statistics)|associated]] with [[rheumatoid arthritis]] include:
* [[Osteopenia]]
* [[Myositis]]
* [[Vasculitis]]
* [[Uveitis]]
* [[Scleritis]]
* [[Periphery|Peripheral]] [[ulcerative keratitis]]
* [[Interstitial fibrosis]]
* [[Pulmonary]] [[nodules]]
* [[Bronchiolitis obliterans]]
* [[Organizing pneumonia]]
* [[Venous thromboembolism]]
* [[Pericarditis]]
* [[Myocarditis]]
* [[Congestive heart failure]]
* [[Atrial fibrillation]]
* [[Sjogren's syndrome]]
* [[Felty's syndrome]]
[[Patients]] with [[rheumatoid arthritis]] may have a positive [[History and Physical examination|history]] of:
* [[Smoking]]
* [[Family history]]
* [[Autoimmune disease]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Hammer toe|'''Hammer toe''']]<ref name="pmid30309185">{{cite journal| author=Ridley LJ, Han J, Ridley WE, Xiang H| title=Claw toe. | journal=J Med Imaging Radiat Oncol | year= 2018 | volume= 62 Suppl 1 | issue=  | pages= 126 | pmid=30309185 | doi=10.1111/1754-9485.07_12786 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30309185  }} </ref><ref name="pmid30553747">{{cite journal| author=Ceccarini P, Rinonapoli G, Sebastiani E, Bisaccia M, Ceccarini A, Caraffa A| title=Clinical Comparison Between Shortening Osteotomy of the Proximal Phalanx Neck and Arthrodesis in Hammer Toe Surgery at Mid-TermFollow-Up. | journal=J Foot Ankle Surg | year= 2019 | volume= 58 | issue= 2 | pages= 221-225 | pmid=30553747 | doi=10.1053/j.jfas.2018.08.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30553747  }} </ref><ref name="pmid29362037">{{cite journal| author=Doty JF, Fogleman JA| title=Treatment of Rigid Hammer-Toe Deformity: Permanent Versus Removable Implant Selection. | journal=Foot Ankle Clin | year= 2018 | volume= 23 | issue= 1 | pages= 91-101 | pmid=29362037 | doi=10.1016/j.fcl.2017.09.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29362037  }} </ref><ref name="pmid29444584">{{cite journal| author=Mueller CM, Boden SA, Boden AL, Maidman SD, Cutler A, Mignemi D et al.| title=Complication Rates and Short-Term Outcomes After Operative Hammertoe Correction in Older Patients. | journal=Foot Ankle Int | year= 2018 | volume= 39 | issue= 6 | pages= 681-688 | pmid=29444584 | doi=10.1177/1071100718755472 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29444584  }} </ref><ref name="pmid25746765">{{cite journal| author=Ceccarini P, Ceccarini A, Rinonapoli G, Caraffa A| title=Correction of Hammer Toe Deformity of Lateral Toes With Subtraction Osteotomy of the Proximal Phalanx Neck. | journal=J Foot Ankle Surg | year= 2015 | volume= 54 | issue= 4 | pages= 601-6 | pmid=25746765 | doi=10.1053/j.jfas.2014.11.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25746765  }} </ref><ref name="pmid26028601">{{cite journal| author=Basile A, Albo F, Via AG| title=Intramedullary Fixation System for the Treatment of Hammertoe Deformity. | journal=J Foot Ankle Surg | year= 2015 | volume= 54 | issue= 5 | pages= 910-6 | pmid=26028601 | doi=10.1053/j.jfas.2015.04.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26028601  }} </ref><ref name="pmid24443491">{{cite journal| author=Catena F, Doty JF, Jastifer J, Coughlin MJ, Stevens F| title=Prospective study of hammertoe correction with an intramedullary implant. | journal=Foot Ankle Int | year= 2014 | volume= 35 | issue= 4 | pages= 319-25 | pmid=24443491 | doi=10.1177/1071100713519780 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24443491  }} </ref><ref name="pmid29337598">{{cite journal| author=Obrador C, Losa-Iglesias M, Becerro-de-Bengoa-Vallejo R, Kabbash CA| title=Comparative Study of Intramedullary Hammertoe Fixation. | journal=Foot Ankle Int | year= 2018 | volume= 39 | issue= 4 | pages= 415-425 | pmid=29337598 | doi=10.1177/1071100717745854 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29337598  }} </ref><ref name="pmid25677363">{{cite journal| author=Kramer WC, Parman M, Marks RM| title=Hammertoe correction with k-wire fixation. | journal=Foot Ankle Int | year= 2015 | volume= 36 | issue= 5 | pages= 494-502 | pmid=25677363 | doi=10.1177/1071100714568013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25677363  }} </ref>
|Can be [[Causes|caused]] by [[muscle]], [[nerve]], or [[Joint (anatomy)|joint]] damage due to any of the following:
 
* [[Wear red day|Wearing]] poorly-fitting [[Shoe insert|shoes]] (high [[Heel|heels]], too short or narrow [[Shoe insert|shoes]])
* [[Trauma]]
* [[Osteoarthritis]]
* [[Rheumatoid arthritis]]
* [[Stroke]]
* [[Charcot-Marie-Tooth disease]]
* [[Diabetes]]
|
* [[Abnormal]] permanent [[Bends|bend]] at the [[proximal interphalangeal joint]] of a [[toe]] due to [[imbalance]] in the [[muscles]], [[ligaments]], or [[tendons]] which normally [[Holdfast|hold]] the [[toe]] in a [[Straight, Incorporated|straight]] [[Position effect|position]]
|
* Usually [[Affect|affects]] [[second]], third, or fourth [[toe]]
* [[Abnormal]] [[Bends|bend]] in the [[Joint (anatomy)|joint]] of one or more [[toes]] resembling a [[Hammer toe|hammer]]
* [[Painful]] or difficult [[Movement disorders|movement]] of the [[Affect|affected]] [[toe]]
*[[Painful]] [[Callus (cell biology)|calluses]] & [[corns]] may [[Formal charge|form]] (due to rubbing of [[Hammer toe|hammer toes]] against the inside of the [[Shoe insert|shoes]])
|Also known as:
 
* [[Claw]] [[toe]]
* [[Hammer toe]] [[syndrome]]
* Mallet [[toe]] (when [[Affect|affects]] the  [[Distal interphalangeal joint|distal interphalangeal joint)]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |'''[[Neurofibroma]]'''<ref name="RodriguezFolpe2012">{{cite journal|last1=Rodriguez|first1=Fausto J.|last2=Folpe|first2=Andrew L.|last3=Giannini|first3=Caterina|last4=Perry|first4=Arie|title=Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems|journal=Acta Neuropathologica|volume=123|issue=3|year=2012|pages=295–319|issn=0001-6322|doi=10.1007/s00401-012-0954-z}}</ref><ref name="ChoiKomurov2017">{{cite journal|last1=Choi|first1=Kwangmin|last2=Komurov|first2=Kakajan|last3=Fletcher|first3=Jonathan S.|last4=Jousma|first4=Edwin|last5=Cancelas|first5=Jose A.|last6=Wu|first6=Jianqiang|last7=Ratner|first7=Nancy|title=An inflammatory gene signature distinguishes neurofibroma Schwann cells and macrophages from cells in the normal peripheral nervous system|journal=Scientific Reports|volume=7|issue=1|year=2017|issn=2045-2322|doi=10.1038/srep43315}}</ref><ref name="LiaoBooker2018">{{cite journal|last1=Liao|first1=Chung-Ping|last2=Booker|first2=Reid C.|last3=Brosseau|first3=Jean-Philippe|last4=Chen|first4=Zhiguo|last5=Mo|first5=Juan|last6=Tchegnon|first6=Edem|last7=Wang|first7=Yong|last8=Clapp|first8=D. Wade|last9=Le|first9=Lu Q.|title=Contributions of inflammation and tumor microenvironment to neurofibroma tumorigenesis|journal=Journal of Clinical Investigation|volume=128|issue=7|year=2018|pages=2848–2861|issn=0021-9738|doi=10.1172/JCI99424}}</ref><ref name="StaserYang2010">{{cite journal|last1=Staser|first1=K.|last2=Yang|first2=F.-C.|last3=Clapp|first3=D. W.|title=Mast cells and the neurofibroma microenvironment|journal=Blood|volume=116|issue=2|year=2010|pages=157–164|issn=0006-4971|doi=10.1182/blood-2009-09-242875}}</ref><ref name="MuirNeubauer2001">{{cite journal|last1=Muir|first1=David|last2=Neubauer|first2=Debbie|last3=Lim|first3=Ingrid T.|last4=Yachnis|first4=Anthony T.|last5=Wallace|first5=Margaret R.|title=Tumorigenic Properties of Neurofibromin-Deficient Neurofibroma Schwann Cells|journal=The American Journal of Pathology|volume=158|issue=2|year=2001|pages=501–513|issn=00029440|doi=10.1016/S0002-9440(10)63992-2}}</ref><ref name="WilkinsonManson2004">{{cite journal|last1=Wilkinson|first1=Lana M.|last2=Manson|first2=David|last3=Smith|first3=Charles R.|title=Best Cases from the AFIP|journal=RadioGraphics|volume=24|issue=suppl_1|year=2004|pages=S237–S242|issn=0271-5333|doi=10.1148/rg.24si035170}}</ref><ref name="BernthalJones2013">{{cite journal|last1=Bernthal|first1=Nicholas|last2=Jones|first2=Kevin|last3=Monument|first3=Michael|last4=Liu|first4=Ting|last5=Viskochil|first5=David|last6=Randall|first6=R.|title=Lost in Translation: Ambiguity in Nerve Sheath Tumor Nomenclature and Its Resultant Treatment Effect|journal=Cancers|volume=5|issue=4|year=2013|pages=519–528|issn=2072-6694|doi=10.3390/cancers5020519}}</ref><ref name="StaserYang2010">{{cite journal|last1=Staser|first1=K.|last2=Yang|first2=F.-C.|last3=Clapp|first3=D. W.|title=Mast cells and the neurofibroma microenvironment|journal=Blood|volume=116|issue=2|year=2010|pages=157–164|issn=0006-4971|doi=10.1182/blood-2009-09-242875}}</ref><ref name="MautnerFriedrich2003">{{cite journal|last1=Mautner|first1=V. F.|last2=Friedrich|first2=R. E.|last3=von Deimling|first3=A.|last4=Hagel|first4=C.|last5=Korf|first5=B.|last6=Knöfel|first6=M. T.|last7=Wenzel|first7=R.|last8=Fünsterer|first8=C.|title=Malignant peripheral nerve sheath tumours in neurofibromatosis type 1: MRI supports the diagnosis of malignant plexiform neurofibroma|journal=Neuroradiology|volume=45|issue=9|year=2003|pages=618–625|issn=0028-3940|doi=10.1007/s00234-003-0964-6}}</ref><ref name="ShenHarper1996">{{cite journal|last1=Shen|first1=M H|last2=Harper|first2=P S|last3=Upadhyaya|first3=M|title=Molecular genetics of neurofibromatosis type 1 (NF1).|journal=Journal of Medical Genetics|volume=33|issue=1|year=1996|pages=2–17|issn=1468-6244|doi=10.1136/jmg.33.1.2}}</ref><ref name="RubinGutmann2005">{{cite journal|last1=Rubin|first1=Joshua B.|last2=Gutmann|first2=David H.|title=Neurofibromatosis type 1 — a model for nervous system tumour formation?|journal=Nature Reviews Cancer|volume=5|issue=7|year=2005|pages=557–564|issn=1474-175X|doi=10.1038/nrc1653}}</ref><ref name="Gray1990">{{cite journal|last1=Gray|first1=Mark H.|title=Immunohistochemical Demonstration of Factor XIIIa Expression in Neurofibromas|journal=Archives of Dermatology|volume=126|issue=4|year=1990|pages=472|issn=0003-987X|doi=10.1001/archderm.1990.01670280056009}}</ref>
|Can be sporadic or as a part of [[Neurofibromatosis 1]] and 2
* ''[[Neurofibromatosis type I|NF1]] [[gene]] located at [[chromosomal]] region [[CCL7|17q11.2]], [[Code|codes]]<nowiki/>for''[[neurofibromin]]
* Functional part of [[neurofibromin]] GAP (or [[GTPase-activating proteins|GTPase-activating protein]]) accelerates the [[Conversion (logic)|conversion]]<nowiki/>of the active [[GTP-binding protein|GTP]]-bound [[RAS]] to its inactive GDP-[[Bound state|bound]] form
* Loss of ''[[RAS]]'' [[control]]<nowiki/>leads to increased [[Activity (chemistry)|activity]] of other [[Signaling pathway|signaling pathways]]<nowiki/>including ''[[C-Raf|RAF]]'', ''[[Extracellular signal-regulated kinases|ERK1/2]]'', ''[[Phosphoinositide 3-kinase|PI3K]]'', ''[[PAK1|PAK]], [[MAPK]], [[SCF-complex|SCF]]/[[c-kit]]'' and ''[[Mammalian target of rapamycin|mTOR-S6 kinase]]''
|
* Uniphasic, low to moderate cellularity
* No peripheral perineural [[capsule]]
* [[Random]] [[pattern]], only [[rare]]<nowiki/> palisading
* No well formed verocy bodies
* Hypocellular with abundant [[mucinous]]/myxoid [[matrix]]<nowiki/>without hypercellular [[Area|areas]]
* Frequent [[mast cells]]
* Contains [[neural]] [[fibroblasts]]<nowiki/>and fibrillary or shredded carrot [[collagen]]
* [[Random]] [[proliferation]] of [[Schwann cells]] and scattered admixed [[axons]]
* No [[Nevi|nevoid cells]]
* No [[epithelial]] component
* [[Diffuse]] [[growth]] [[pattern]]
* Scant [[cytoplasm]]
* Wavy [[spindle cells]] with buckled [[nuclei]]
* Pseudomeissnerian [[Body|bodies]]<nowiki/>representing specific [[differentiation]] may be present
* Lacks storiform [[pattern]]
[[Neurofibroma]] with [[degenerative]][[atypia]] ("ancient [[Change detection|change]]") has following [[microscopic]] [[Features (pattern recognition)|features]]:
* [[Localized disease|Localized]] [[Cells (biology)|cells]] with large [[pleomorphic]] [[nuclei]], [[cytoplasmic]] [[nuclear]][[inclusions]], smudgy [[chromatin]], and inconspicuous [[nuclei]]
* Absent or very low [[Mitotic|mitotic activity]]
* Low to moderate cellularity
|
* Can occur anywhere
* [[Diffuse]] [[neurofibroma]]<nowiki/>[[Neurofibroma|s]] commonly involve [[scalp]]
* Soft [[Mass|masses]]/[[Bumps on skin|bumps on or under skin]] ([[internal]] or [[superficial]])
* [[Transient]] [[itching]] ([[mast cells]]<nowiki/>release [[histamine]])
* [[Transient]] [[pain]]
* [[Numbness]] and [[tingling]] in the affected [[area]]
* Severe [[bleeding]] (sign of [[tumor]][[growth]])
* [[Physical therapy|Physical]] disfiguration
* [[Cognitive]] [[disability]]
* [[Stinging in the eye|Stinging]]
* [[Neurological]] [[Deficits in Attention, Motor control and Perception|deficits]]
* [[Change detection|Changes]] in [[Movement disorder|movement]]([[clumsiness]] in [[hands]], trouble [[walking]])
* [[Bowel]] [[incontinence]]
* [[Scoliosis]] (an [[abnormal]] [[Curvature of spine|curvature of the spine]], if the [[tumor]] creates [[muscular]] [[imbalance]] or erodes [[bones]] of the [[spine]])
* Following [[symptoms]] may occur with [[genitourinary tract]]<nowiki/>involvement (rarely):
** [[Urinary tract infection]] (most common [[clinical]]<nowiki/>manifestation)
** [[Urinary retention]]
** [[Urinary frequency]]
** [[Urgency]]
** [[Hematuria]]
** Pelvic mass
** [[Hydronephrosis)|Hydronephrosis]]
** [[Urinary incontinence]](decreased [[Urinary bladder|bladder]] capacity or [[compliance]])
** [[Appearance|Appears]] as a focal [[mass]] or [[diffuse]] [[Urinary bladder|bladder]] wall thickening in case of a [[plexiform neurofibroma]]
|
* [[Nerve]] often not identified, incorporates [[nerve]], [[axons]]<nowiki/>often present in [[lesion]]
* Seldom [[cystic]]
* Frequently multiple
* Widespread [[soft tissue]][[Infiltration (medical)|infiltration]]
* Tends to displace [[Adnexal and skin appendage neoplasms|adnexa]]
* <2cm in [[diameter]]
* [[Lack (manque)|Lacks]] [[Distinctive feature|distinct]] [[Lobule|lobulation]]
* [[Lack (manque)|Lacks]] [[fat]]
* Affects [[Individual growth|individuals]] between 20-40 [[Year|years]] of [[age]]
* Men and women are [[Equalism|equally]]<nowiki/>affected
* [[Plexiform neurofibroma]] are thought to be [[Congenital disorder|congenital]] and occur earlier in [[life]]
|}


==References==
==References==

Latest revision as of 20:48, 19 August 2020

Neuroma Microchapters

Overview

Historical Perspective

Classification

Morton's neuroma
Acoustic neuroma
Ganglioneuroma

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [7]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[8], Maria Fernanda Villarreal, M.D. [9]

Synonyms and keywords: Traumatic neuroma; Morton neuroma; Amputation neuroma; Pseudoneuroma; Morton’s metatarsalgia; Plantar interdigital neuroma; Morton's intermetatarsal neuroma; Morton's entrapment; Morton's disease; Morton's neuropathy; Morton's neuralgia; Intermetatarsal neuroma; Intermetatarsal space neuroma; Intermetatarsal nerve entrapment; Interdigital neuroma; Interdigital nerve compression; Interdigital nerve enlargement; Joplin's neuroma; Plantar neuroma; Scar neuroma; Terminal neuroma; Stump neuroma

Overview

Neuroma (Neuro- is from the Greek for nerve) is defined as a benign tumor of a nerve. However, neuroma commonly refers to any tumor of cells of the nervous system. Neuromas form part of the peripheral nerve sheath tumors and belong to Reactive class of tumors. Neuroma was first described by Thomas Morton in 1876. Neuromas may be classified according to histopathological features into 3 groups: Morton's neuroma, traumatic neuroma, and neoplasic neuromas. The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis. Neuroma is more commonly observed among patients aged between 15 to 50 years old. Neuroma is more commonly observed among middle aged adults. Females are more commonly affected with neuroma than males. The female to male ratio is approximately 5:1. Common risk factors in the development of neuroma include improper footwear and high impact sports (e.g., rock-climbing, ballet dancing). A major complication of neuroma is chronic neuropathic pain. On ultrasound, neuroma is characterized as a well-defined, hypoechoic lesion located in the intermetatarsal space proximal to the metatarsal head. Patients with neuroma usually appear with antalgic posture. Physical examination may be remarkable for tenderness to palpation and dysesthetic pain. Surgical excision is the treatment of choice for patients with neuroma; this surgical intervention is associated with a relatively favorable success rate, approximately 80%. The recurrence rate after surgery is as high as 50%.

Historical Perspective

  • The term neuroma originates from the following two Greek words:
  • In 1876, Neuroma was first described by Thomas Morton

Classification

Classification of neuroma
Types of neuroma Characteristic features Neoplastic nature
Morton's neuroma[5][6][7][8][9][10] Non-neoplastic
Traumatic neuroma[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]
Palisaded encapsulated neuroma/solitary circumscribed neuroma
Mucosal neuroma[4][28]
Neoplasic neuroma Neoplastic
Acoustic neuroma [29]
Ganglioneuroma
Pacinian neuroma[30][31][32][33]

Pathophysiology

S-100 Immunostain of Palisaded and Encapsulated Neuroma Source: Ed Uthman at flickr
Histopathology of Palisaded and Encapsulated Neuroma Source: Ed Uthman at flickr
Histopathology of Palisaded and Encapsulated Neuroma [1]
Histopathology of Palisaded and Encapsulated Neuroma [2]

Histopathology of traumatic neuroma

Traumatic neuroma Source: Libre Pathology
Traumatic neuroma [3]
Traumatic neuroma [4]
Traumatic neuroma [5]
Traumatic neuroma [6]

Common sites of involvement by traumatic neuroma

Causes

Epidemiology and Demographics

Age

Gender

Race

  • There is no racial predilection for neuroma

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

MRI

Morton neuroma MRI Source: Radiopedia

Ultrasound

Treatment

Medical Therapy

Conservative therapy for Morton's neuroma

Non-conservative medical therapy

Surgery

Prevention

Differential Diagnosis

Differentiating neuroma from other causes of intermetatarsal pain
Disease/Condition Underlying Etiology Pathophysiology Clinical presentation Other associated features
Neuroma


Indirect nerve trauma

Metatarsal stress fracture (Neck of metatarsal bone)[101] Repeated extraordinary stress, overuse, or trauma to the bone caused by any of the following: Stress fracture can be prevented by following measures:
Rheumatoid arthritis[102][103][104][105][106][107] Common causes include: On gross pathology, following features may be noticed:

Microscopic histopathologicalanalysis shows:

Common symptoms of rheumatoid arthritis include: Conditions associated with rheumatoid arthritis include:

Patients with rheumatoid arthritis may have a positive history of:

Hammer toe[108][109][110][111][112][113][114][115][116] Can be caused by muscle, nerve, or joint damage due to any of the following: Also known as:
Neurofibroma[117][118][119][120][121][122][123][120][124][125][126][127] Can be sporadic or as a part of Neurofibromatosis 1 and 2

Neurofibroma with degenerativeatypia ("ancient change") has following microscopic features:

References

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