Neuroma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2] Maria Fernanda Villarreal, M.D. [3]

Synonyms and keywords: Traumatic neuroma; Morton neuroma; Joplin neuroma; Amputation neuroma; Pseudoneuroma; Morton’s metatarsalgia; Plantar interdigital 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. 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

  • In 1876, Neuroma was first described by Thomas Morton

Classification

  • Neuroma may be classified according to histopathological features into following groups:[1][2][3]
    • Morton neuroma[4][5][6]
      • Symptomatic perineural fibrosis around a plantar digital nerve of the foot due to chronic nerve compression
      • Also known as:
        • Morton’s metatarsalgia
        • Plantar interdigital neuroma
    • Traumatic neuroma[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]
      • Arises from nerve injury (often as a result of surgery)
      • They occur at the end of injured nerve fibers as a form of unregulated nerve regeneration
      • Subtype of traumatic neuroma, called "Joplin neuroma" (a compression traumatic neuroma)
      • Occurs most commonly near a scar
      • Often very painful
      • Also known as:
        • Amputation neuroma
        • Pseudoneuroma
    • Neoplasic neuroma
      • Solid nodular mass
      • Usually, separate from nerve fibers
    • Acoustic neuroma - this is misnomer; it is actually a Schwannoma
    • Palisaded encapsulated neuroma

Pathophysiology

  • The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis[1]
  • The pathogenesis of traumatic neuroma is characterized by:[24][14][25]
    • Tangle of neural fibers and connective tissue that 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
    • Chronic reactive fibroinflammatory disorganized regeneration around a nerve after an injury (such as traction injury or chronic repetitive stress)
  • Morton neuroma is characterized by being located in the 3rd web-space, between 3rd and 4th metatarsal heads[26]
  • 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)
  • There are no genetic mutations associated with the development of neuroma
  • On gross pathology, characteristic findings of neuroma, include:[27][28]
  • On microscopic histopathological analysis, characteristic findings of neuroma, include:[27][28]
    • Extensive fibrosis around and within the nerve
    • Digital artery
    • Thrombosis
    • Arterial thickening

Histopathology of traumatic neuroma

  • Numerous well formed small nerve twigs
  • Limited soft tissue infiltration
  • Contains axons in haphazardly arranged nerves within mature collagenous scar with entrapped smooth muscle
Traumatic neuroma Source: Libre Pathology

Common sites of involvement by traumatic neuroma

  • Most common oral locations are:
    • Tongue
    • Near mental foramen of mouth
  • Rarely involves:
    • Head
    • Neck

Causes

  • Common causes of neuroma include:[27][28]
  • Indirect nerve trauma
  • Traction injury
  • Chronic repetitive stress

Differentiating Neuroma from other Diseases

  • Neuroma must be differentiated from other diseases that cause forefoot pain and numbness such as:[1][28]

Epidemiology and Demographics

  • Neuroma is a uncommon disease[28]

Age

  • Neuroma is more commonly observed among patients aged between 15 to 50 years old[28]
  • Neuroma is more commonly observed among middle aged adults

Gender

  • Females are more commonly affected with neuroma than males
  • The female to male ratio is approximately 5:1[28]

Race

  • There is no racial predilection for neuroma

Risk Factors

  • Common risk factors in the development of neuroma include:[27]
  • Improper footwear
  • High-impact sports (e.g., rock-climbing, ballet dancing)

Natural History, Complications and Prognosis

  • The majority of patients with neuroma are symptomatic at the time of diagnosis[1]
  • Early clinical features include neuropathic pain or local tenderness
  • If left untreated, the majority of patients with neuroma may progress to develop difficulty walking and limping
  • A significant complication of neuroma is chronic neuropathic pain
  • Prognosis is generally good, and the survival rate of patients with neuroma is 99%[29][30]

Diagnosis

Symptoms

Physical Examination

  • Patients with neuroma usually appear with antalgic posture[1]
  • Physical examination may be remarkable for:

Laboratory Findings

  • There are no specific laboratory findings associated with neuroma[27]

Imaging Findings

MRI

  • On MRI, characteristic findings of neuroma include:[31][32][33][34][35][36][37][38][6][39]
    • Dumbbell/ovoid-shaped lesion at a similar position to that described on ultrasound
    • T1: typically low-to-iso signal
    • T2: typically low signal but can sometimes be intermediate in signal
    • T1 C+ (Gd): tends to show intense enhancement
  • On MRI, characteristic findings of traumatic neuroma include:[1]
    • Fusiform swelling of a nerve or a bulbous mass at a nerve end
    • The parent nerve of some small nerve may difficult or impossible to discern
    • T2/STIR:inhomogeneous hyperintensity (may have a hypointense rim)
    • T1 C+ (Gd): variable contrast enhancement
Morton neuroma MRI Source: Radiopedia

Ultrasound

  • On ultrasound, neuroma is characterized by the following findings:[1][40][41][42][43][44][45][46][47][5][48]
    • Round to ovoid
    • Well-defined, hypoechoic lesion
    • Located in the intermetatarsal space proximal to the metatarsal head
  • On ultrasound, traumatic neuroma is characterized by the following findings:[1]
    • Swollen nerve (mass-like)
    • Hypoechoic
    • Loss of normal fibrillar pattern
    • Usually small, but may be as large as 5 cm

Treatment

Medical Therapy

Surgery

  • Surgery is the mainstay of therapy for neuroma[63][64][65][66][67][68][69][70][71][72][73][74][75][29]
  • 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%

Prevention

  • There are no primary preventive measures available for neuroma[1]
  • Secondary prevention measures include: personal hygiene measures, such as wearing ergonomic shoes

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016
  2. ↑ "Neuroma". Dorland's Illustrated Medical Dictionary (32nd ed.). Oxford University Press. 2011. p. 5287. ISBN 978-1-4557-0985-4. Retrieved 25 August 2013.
  3. ↑ Valero J, Gallart J, González D, Deus J, Lahoz M (2015). "Multiple interdigital neuromas: a retrospective study of 279 feet with 462 neuromas". J Foot Ankle Surg. 54 (3): 320–2. doi:10.1053/j.jfas.2014.05.011. PMID 25128316.
  4. ↑ Kim JY, Choi JH, Park J, Wang J, Lee I (2007). "An anatomical study of Morton's interdigital neuroma: the relationship between the occurring site and the deep transverse metatarsal ligament (DTML)". Foot Ankle Int. 28 (9): 1007–10. doi:10.3113/FAI.2007.1007. PMID 17880876.
  5. ↑ 5.0 5.1 Read JW, Noakes JB, Kerr D, Crichton KJ, Slater HK, Bonar F (1999). "Morton's metatarsalgia: sonographic findings and correlated histopathology". Foot Ankle Int. 20 (3): 153–61. doi:10.1177/107110079902000303. PMID 10195292.
  6. ↑ 6.0 6.1 Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E (2000). "Morton's neuroma: is it always symptomatic?". AJR Am J Roentgenol. 175 (3): 649–53. doi:10.2214/ajr.175.3.1750649. PMID 10954445.
  7. ↑ Foltán R, Klíma K, Spacková J, Sedý J (2008). "Mechanism of traumatic neuroma development". Med Hypotheses. 71 (4): 572–6. doi:10.1016/j.mehy.2008.05.010. PMID 18599222.
  8. ↑ Yao C, Zhou X, Zhao B, Sun C, Poonit K, Yan H (2017). "Treatments of traumatic neuropathic pain: a systematic review". Oncotarget. 8 (34): 57670–57679. doi:10.18632/oncotarget.16917. PMC 5593675. PMID 28915703.
  9. ↑ Colella G, Borriello C, Lanza A, Rossiello R, Siniscalchi G (2002). "[Traumatic neuroma of the great auricular nerve. A clinical case]". Minerva Stomatol. 51 (6): 279–83. PMID 12147981.
  10. ↑ Moss CE, Johnston CJ, Whear NM (2000). "Amputation neuroma of the great auricular nerve after operations on the parotid gland". Br J Oral Maxillofac Surg. 38 (5): 537–8. doi:10.1054/bjom.2000.0466. PMID 11010790.
  11. ↑ Hobsley M (1972). "Amputation neuroma of the great auricular nerve after parotidectomy". Br J Surg. 59 (9): 735–6. PMID 4341800.
  12. ↑ Toriumi DM, Sykes J, Wolff A (1987). "Pathologic quiz case 1. Amputation neuroma of the great auricular nerve". Arch Otolaryngol Head Neck Surg. 113 (8): 888–90. PMID 3620156.
  13. ↑ De Roos KP, Neumann HA (1994). "Traumatic neuroma. A rare complication following Muller's phlebectomy". J Dermatol Surg Oncol. 20 (10): 681–2. PMID 7930014.
  14. ↑ 14.0 14.1 Lee EJ, Calcaterra TC, Zuckerbraun L (1998). "Traumatic neuromas of the head and neck". Ear Nose Throat J. 77 (8): 670–4, 676. PMID 9745184.
  15. ↑ Li Q, Gao EL, Yang YL, Hu HY, Hu XQ (2012). "Traumatic neuroma in a patient with breast cancer after mastectomy: a case report and review of the literature". World J Surg Oncol. 10: 35. doi:10.1186/1477-7819-10-35. PMC 3296625. PMID 22330690.
  16. ↑ Chen W, Zhang H, Huang J, Li Y, Zhang Z, Peng Y (2019). "Traumatic neuroma in mastectomy scar: Two case reports and review of the literature". Medicine (Baltimore). 98 (15): e15142. doi:10.1097/MD.0000000000015142. PMID 30985684.
  17. ↑ Baltalarli B, Demirkan N, Yağci B (2004). "Traumatic neuroma: unusual benign lesion occurring in the mastectomy scar". Clin Oncol (R Coll Radiol). 16 (7): 503–4. PMID 15490816.
  18. ↑ Rosso R, Scelsi M, Carnevali L (2000). "Granular cell traumatic neuroma: a lesion occurring in mastectomy scars". Arch Pathol Lab Med. 124 (5): 709–11. doi:10.1043/0003-9985(2000)124<0709:GCTN>2.0.CO;2. PMID 10782152.
  19. ↑ Nomura H, Harimaya K, Orii H, Shiba K, Ueta T, Iwaki T (2002). "Traumatic neuroma of the anterior cervical nerve root with no subjective episode of trauma. Report of four cases". J Neurosurg. 97 (3 Suppl): 393–6. PMID 12408400.
  20. ↑ Arishima H, Takeuchi H, Tsunetoshi K, Kodera T, Kitai R, Kikuta K (2013). "Intraoperative and pathological findings of intramedullary amputation neuroma associated with spinal ependymoma". Brain Tumor Pathol. 30 (3): 196–200. doi:10.1007/s10014-012-0125-x. PMC 3714552. PMID 23187747.
  21. ↑ Ulrich CT, Sommerlad D, Szelenyi A, Seifert V, Marquardt G (2010). "Concurrent schwannoma and intradural neuroma after resection of a cauda equina schwannoma. A case report and first description". Acta Neurochir (Wien). 152 (6): 1061–3, discussion 1063. doi:10.1007/s00701-009-0534-8. PMID 19834641.
  22. ↑ Salas SJ, McFalls JM, Senders ZJ, Kenyon LC, Harrop JS (2013). "Intradural cervical nerve root traumatic neuroma without a history of direct trauma". Clin Neurol Neurosurg. 115 (9): 1879–81. doi:10.1016/j.clineuro.2013.03.018. PMID 23639732.
  23. ↑ Kang J, Yang P, Zang Q, He X (2016). "Traumatic neuroma of the superficial peroneal nerve in a patient: a case report and review of the literature". World J Surg Oncol. 14 (1): 242. doi:10.1186/s12957-016-0990-6. PMC 5018173. PMID 27613606.
  24. ↑ Kitcat M, Hunter JE, Malata CM (2009). "Sciatic neuroma presenting forty years after above-knee amputation". Open Orthop J. 3: 125–7. doi:10.2174/1874325000903010125. PMC 2835865. PMID 20224738.
  25. ↑ Hanna SA, Catapano J, Borschel GH (2016). "Painful pediatric traumatic neuroma: surgical management and clinical outcomes". Childs Nerv Syst. 32 (7): 1191–4. doi:10.1007/s00381-016-3109-z. PMID 27179535.
  26. ↑ Perry, Arie (2010). Practical surgical neuropathology : a diagnostic approach. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0443069826.
  27. ↑ 27.0 27.1 27.2 27.3 27.4 Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016
  28. ↑ 28.0 28.1 28.2 28.3 28.4 28.5 28.6 Wu J, Chiu DT (1999). "Painful neuromas: a review of treatment modalities". Ann Plast Surg. 43 (6): 661–7. PMID 10597831.
  29. ↑ 29.0 29.1 Lee KT, Kim JB, Young KW, Park YU, Kim JS, Jegal H (2011). "Long-term results of neurectomy in the treatment of Morton's neuroma: more than 10 years' follow-up". Foot Ankle Spec. 4 (6): 349–53. doi:10.1177/1938640011428510. PMID 22134434.
  30. ↑ Bauer T, Gaumetou E, Klouche S, Hardy P, Maffulli N (2015). "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". J Foot Ankle Surg. 54 (3): 373–7. doi:10.1053/j.jfas.2014.08.009. PMID 25481724.
  31. ↑ AlSharif S, Ferré R, Omeroglu A, El Khoury M, Mesurolle B (2016). "Imaging Features Associated With Posttraumatic Breast Neuromas". AJR Am J Roentgenol. 206 (3): 660–5. doi:10.2214/AJR.14.14035. PMID 26901025.
  32. ↑ Ahlawat S, Belzberg AJ, Montgomery EA, Fayad LM (2016). "MRI features of peripheral traumatic neuromas". Eur Radiol. 26 (4): 1204–12. doi:10.1007/s00330-015-3907-9. PMID 26188658.
  33. ↑ Zanetti M, Ledermann T, Zollinger H, Hodler J (1997). "Efficacy of MR imaging in patients suspected of having Morton's neuroma". AJR Am J Roentgenol. 168 (2): 529–32. doi:10.2214/ajr.168.2.9016241. PMID 9016241.
  34. ↑ Williams JW, Meaney J, Whitehouse GH, Klenerman L, Hussein Z (1997). "MRI in the investigation of Morton's neuroma: which sequences?". Clin Radiol. 52 (1): 46–9. PMID 9022580.
  35. ↑ Unger HR, Mattoso PQ, Drusen MJ, Neumann CH (1992). "Gadopentetate-enhanced magnetic resonance imaging with fat saturation in the evaluation of Morton's neuroma". J Foot Surg. 31 (3): 244–6. PMID 1619223.
  36. ↑ Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee JW; et al. (2007). "Morton neuroma: evaluated with ultrasonography and MR imaging". Korean J Radiol. 8 (2): 148–55. doi:10.3348/kjr.2007.8.2.148. PMC 2626779. PMID 17420632.
  37. ↑ Weishaupt D, Treiber K, Kundert HP, Zollinger H, Vienne P, Hodler J; et al. (2003). "Morton neuroma: MR imaging in prone, supine, and upright weight-bearing body positions". Radiology. 226 (3): 849–56. doi:10.1148/radiol.2263011925. PMID 12601213.
  38. ↑ Torres-Claramunt R, Ginés A, Pidemunt G, Puig L, de Zabala S (2012). "MRI and ultrasonography in Morton's neuroma: Diagnostic accuracy and correlation". Indian J Orthop. 46 (3): 321–5. doi:10.4103/0019-5413.96390. PMC 3377144. PMID 22719120.
  39. ↑ Weishaupt D, Treiber K, Jacob HA, Kundert HP, Hodler J, Marincek B; et al. (2002). "MR imaging of the forefoot under weight-bearing conditions: position-related changes of the neurovascular bundles and the metatarsal heads in asymptomatic volunteers". J Magn Reson Imaging. 16 (1): 75–84. doi:10.1002/jmri.10130. PMID 12112506.
  40. ↑ Coraci D, Pazzaglia C, Doneddu PE, Erra C, Paolasso I, Santilli V; et al. (2015). "Post-traumatic neuroma due to closed nerve injury. Is recovery after peripheral nerve trauma related to ultrasonographic neuroma size?". Clin Neurol Neurosurg. 139: 314–8. doi:10.1016/j.clineuro.2015.10.034. PMID 26571458.
  41. ↑ Quinn TJ, Jacobson JA, Craig JG, van Holsbeeck MT (2000). "Sonography of Morton's neuromas". AJR Am J Roentgenol. 174 (6): 1723–8. doi:10.2214/ajr.174.6.1741723. PMID 10845513.
  42. ↑ Pollak RA, Bellacosa RA, Dornbluth NC, Strash WW, Devall JM (1992). "Sonographic analysis of Morton's neuroma". J Foot Surg. 31 (6): 534–7. PMID 1469213.
  43. ↑ Tobajas Asensio E, Tobajas Asensio JA, Boada Apilluelo E, Torres Nuez J (2000). "[Echography evaluation of Morton's neuroma]". An Med Interna. 17 (8): 416–8. PMID 11218988.
  44. ↑ Shapiro PP, Shapiro SL (1995). "Sonographic evaluation of interdigital neuromas". Foot Ankle Int. 16 (10): 604–6. doi:10.1177/107110079501601003. PMID 8574369.
  45. ↑ Sobiesk GA, Wertheimer SJ, Schulz R, Dalfovo M (1997). "Sonographic evaluation of interdigital neuromas". J Foot Ankle Surg. 36 (5): 364–6. PMID 9356915.
  46. ↑ Levine SE, Myerson MS, Shapiro PP, Shapiro SL (1998). "Ultrasonographic diagnosis of recurrence after excision of an interdigital neuroma". Foot Ankle Int. 19 (2): 79–84. doi:10.1177/107110079801900205. PMID 9498579.
  47. ↑ Kankanala G, Jain AS (2007). "The operational characteristics of ultrasonography for the diagnosis of plantar intermetatarsal neuroma". J Foot Ankle Surg. 46 (4): 213–7. doi:10.1053/j.jfas.2007.04.001. PMID 17586431.
  48. ↑ Perini L, Del Borrello M, Cipriano R, Cavallo A, Volpe A (2006). "Dynamic sonography of the forefoot in Morton's syndrome: correlation with magnetic resonance and surgery". Radiol Med. 111 (7): 897–905. doi:10.1007/s11547-006-0088-2. PMID 17021692.
  49. ↑ Malessy MJA, de Boer R, Muñoz Romero I, Eekhof JLA, van Zwet EW, Kliot M; et al. (2018). "Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered". PLoS One. 13 (9): e0203345. doi:10.1371/journal.pone.0203345. PMC 6135496. PMID 30208078.
  50. ↑ Climent JM, Mondéjar-Gómez F, Rodríguez-Ruiz C, Díaz-Llopis I, Gómez-Gallego D, Martín-Medina P (2013). "Treatment of Morton neuroma with botulinum toxin A: a pilot study". Clin Drug Investig. 33 (7): 497–503. doi:10.1007/s40261-013-0090-0. PMC 3691490. PMID 23740337.
  51. ↑ Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D; et al. (2013). "Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial". J Bone Joint Surg Am. 95 (9): 790–8, S1. doi:10.2106/JBJS.I.01780. PMID 23636185.
  52. ↑ Schon L (2014). "An injection of corticosteroid plus anesthetic was more effective than anesthetic alone for Morton neuroma". J Bone Joint Surg Am. 96 (4): 334. doi:10.2106/JBJS.9604.ebo028. PMID 24553891.
  53. ↑ Smith RW (2013). "Steroid injection for Morton neuroma - data-based justification". J Bone Joint Surg Am. 95 (9): e64. doi:10.2106/JBJS.M.00172. PMID 23636203.
  54. ↑ Haddad-Zebouni S, Elia D, Aoun N, Okais J, Ghossain M (2006). "[Regression of Morton neuroma after local injection of steroids]". J Radiol. 87 (5): 566–8. PMID 16733414.
  55. ↑ Basadonna PT, Rucco V, Gasparini D, Onorato A (1999). "Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: a case report". Am J Phys Med Rehabil. 78 (3): 283–5. PMID 10340428.
  56. ↑ Reddy PD, Zelicof SB, Ruotolo C, Holder J (1995). "Interdigital neuroma. Local cutaneous changes after corticosteroid injection". Clin Orthop Relat Res (317): 185–7. PMID 7671475.
  57. ↑ van Vendeloo SN, Ettema HB (2016). "Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma". Foot Ankle Surg. 22 (2): 139–41. doi:10.1016/j.fas.2016.01.002. PMID 27301735.
  58. ↑ Park YH, Lee JW, Choi GW, Kim HJ (2018). "Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton's neuroma". Int Orthop. 42 (2): 323–329. doi:10.1007/s00264-017-3707-8. PMID 29230531.
  59. ↑ Mahadevan D, Salmasi M, Whybra N, Nanda A, Gaba S, Mangwani J (2016). "What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma?". Foot Ankle Surg. 22 (1): 9–11. doi:10.1016/j.fas.2015.03.007. PMID 26869493.
  60. ↑ Mahadevan D, Attwal M, Bhatt R, Bhatia M (2016). "Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial". Bone Joint J. 98-B (4): 498–503. doi:10.1302/0301-620X.98B4.36880. PMID 27037432.
  61. ↑ Yap LP, McNally E (2012). "Patient's assessment of discomfort during ultrasound-guided injection of Morton's neuroma: selecting the optimal approach". J Clin Ultrasound. 40 (6): 330–4. doi:10.1002/jcu.21926. PMID 22585530.
  62. ↑ Hughes RJ, Ali K, Jones H, Kendall S, Connell DA (2007). "Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases". AJR Am J Roentgenol. 188 (6): 1535–9. doi:10.2214/AJR.06.1463. PMID 17515373.
  63. ↑ Souza JM, Purnell CA, Cheesborough JE, Kelikian AS, Dumanian GA (2016). "Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts". Foot Ankle Int. 37 (10): 1098–1105. doi:10.1177/1071100716655348. PMC 5363503. PMID 27340257.
  64. ↑ Bibbo C, Rodrigues-Colazzo E, Finzen AG (2018). "Superficial Peroneal Nerve to Deep Peroneal Nerve Transfer With Allograft Conduit for Neuroma in Continuity". J Foot Ankle Surg. 57 (3): 514–517. doi:10.1053/j.jfas.2017.11.022. PMID 29685562.
  65. ↑ Gould JS, Naranje SM, McGwin G, Florence M, Cheppalli S (2013). "Use of collagen conduits in management of painful neuromas of the foot and ankle". Foot Ankle Int. 34 (7): 932–40. doi:10.1177/1071100713478927. PMID 23447512.
  66. ↑ Rungprai C, Cychosz CC, Phruetthiphat O, Femino JE, Amendola A, Phisitkul P (2015). "Simple Neurectomy Versus Neurectomy With Intramuscular Implantation for Interdigital Neuroma: A Comparative Study". Foot Ankle Int. 36 (12): 1412–24. doi:10.1177/1071100715596741. PMID 26297693.
  67. ↑ Williams EH, Williams CG, Rosson GD, Heitmiller RF, Dellon AL (2008). "Neurectomy for treatment of intercostal neuralgia". Ann Thorac Surg. 85 (5): 1766–70. doi:10.1016/j.athoracsur.2007.11.058. PMID 18442581.
  68. ↑ Sood MK, Elliot D (1998). "Treatment of painful neuromas of the hand and wrist by relocation into the pronator quadratus muscle". J Hand Surg Br. 23 (2): 214–9. PMID 9607662.
  69. ↑ Atherton DD, Leong JC, Anand P, Elliot D (2007). "Relocation of painful end neuromas and scarred nerves from the zone II territory of the hand". J Hand Surg Eur Vol. 32 (1): 38–44. doi:10.1016/j.jhsb.2006.10.013. PMID 17126969.
  70. ↑ Hazari A, Elliot D (2004). "Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation". J Hand Surg Br. 29 (4): 338–50. doi:10.1016/j.jhsb.2004.01.005. PMID 15234497.
  71. ↑ Atherton DD, Fabre J, Anand P, Elliot D (2008). "Relocation of painful neuromas in Zone III of the hand and forearm". J Hand Surg Eur Vol. 33 (2): 155–62. doi:10.1177/1753193408087107. PMID 18443055.
  72. ↑ Mackinnon SE, Dellon AL (1987). "Results of treatment of recurrent dorsoradial wrist neuromas". Ann Plast Surg. 19 (1): 54–61. PMID 3631861.
  73. ↑ Park EH, Kim YS, Lee HJ, Koh YG (2013). "Metatarsal shortening osteotomy for decompression of Morton's neuroma". Foot Ankle Int. 34 (12): 1654–60. doi:10.1177/1071100713499905. PMID 23892930.
  74. ↑ Preston N, Peterson D, Allen J, Kawalec JS, Whitaker J (2018). "Deep Transverse Metatarsal Ligament Transection in Morton's Neuroma Excision: A Cadaveric Study Examining Effects on Metatarsal Alignment". Foot Ankle Spec. 11 (4): 342–346. doi:10.1177/1938640017735888. PMID 29047294.
  75. ↑ Kasparek M, Schneider W (2016). "Transection of the deep metatarsal transverse ligament in Morton's neuroma surgery does not increase risk of splayfoot development". Int Orthop. 40 (5): 953–7. doi:10.1007/s00264-015-2981-6. PMID 26344448.
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