Abstract
BackgroundThe aim of this retrospective study was to examine if a correlation between Morton’s Neuroma (MN) and an increased interphalangeal angle (IPA) or intermetatarsal angle (IMA) can be found in preoperative weightbearing dorsal-plantar X-rays of the foot.MethodsForty-five patients with forty-nine MN in the interspaces 2/3 or 3/4 and 49 controls were recruited for this study. Every MN was matched with an asymptomatic control without history of metatarsalgia. The diagnosis was made by clinical examination, magnetic resonance imaging (MRI) and positive histopathology after operative resection. IMA 1/5, 2/3, 2/4, 2/5, 3/4 and IPA 2/3, 3/4 were measured for both groups.ResultsThe IPA 3/4 was significantly enlarged by 2.8 degrees (p < 0.001) with Area under the curve (AUC) 0.75 (p < 0.001), sensitivity of 73% and specificity of 67% in feet with MN compared to controls. The IMA 3/4 was significantly enlarged by 1 degree (p < 0.048) with AUC 0.64 (p < 0.031), sensitivity of 71% and specificity of 43% in feet with MN compared to controls. No difference between IMA 2/4, 2/5, 1/5 or correlation between IPA or IMA and the size of the MN in the MRI was found.ConclusionThe results confirm the clinical observation of an increased IPA in patients with MN. An increased IPA should therefore be considered in the diagnosis of MN.
Highlights
The aim of this retrospective study was to examine if a correlation between Morton’s Neuroma (MN) and an increased interphalangeal angle (IPA) or intermetatarsal angle (IMA) can be found in preoperative weightbearing dorsal-plantar X-rays of the foot
A simple radiographic measurement of digital divergence might be highly helpful to facilitate the diagnosis of a MN that sometimes can be difficult to distinguish from other forefoot disorders, especially when an magnetic resonance imaging (MRI) or an experienced ultrasound examiner is not available
By using weightbearing DP X-rays of the foot, we aimed to review this issue and analyze, if there is an association between MN and an increased interphalangeal angle (IPA) or intermetatarsal angle (IMA) in the affected interspace
Summary
The aim of this retrospective study was to examine if a correlation between Morton’s Neuroma (MN) and an increased interphalangeal angle (IPA) or intermetatarsal angle (IMA) can be found in preoperative weightbearing dorsal-plantar X-rays of the foot. The MN is usually located proximal to the bifurcation in the digital nerves, just distal to the dorsal metatarsal transverse ligament (DMTL) and consists of a thickening of the interdigital nerve [15]. It has a fusiform configuration, a soft consistency and a white to yellowish appearance. Dorsal-plantar (DP) X-rays of the foot are essential to investigate other causes of metatarsalgia like tarsal– metatarsal joint pathologies, Freiberg’s disease, toe deformities or metatarsal–phalangeal instabilities [19, 20]. An increased digital divergence in the intermetatarsal space affected by MN, that can be seen radiographically, was described before [21, 22]. Previous studies investigated a digital divergence radiographically caused by the MN, but failed to demonstrate a significant relationship [23, 24]
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