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Franco H, Pagliaro T, Sparti C, Walsh HJ. Comparing Clinical Examination and Radiological Evaluation in the Preoperative Diagnosis and Location of Symptomatic Interdigital (Morton's) Neuroma. J Foot Ankle Surg 2023; 62:883-887. [PMID: 37353000 DOI: 10.1053/j.jfas.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/08/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
This study investigates whether clinical examination is as sensitive as ultrasound and magnetic resonance imaging (MRI) in the diagnosis and localization of symptomatic interdigital neuroma. A retrospective cohort study was conducted at two tertiary centers on all consecutive patients who underwent excision by a single foot and ankle specialist surgeon for a presumed interdigital neuroma between January 2008 and December 2020. Investigators collected preoperative clinical findings, radiological investigations, and postoperative outcomes. Sensitivity and positive predictive values were calculated and Z-score for 2 populations proportions was performed. One hundred fourteen consecutive patients were operated on for 131 suspected interdigital neuroma. Thirteen patients were excluded due to lack of adequate clinical documentation. Of the remaining 101 patients with 118 suspected interdigital neuroma, 115 were confirmed histologically (97.5%). The sensitivity of clinical assessment to accurately diagnose and place an interdigital neuroma in the correct space was calculated as 96.5%. The most common preoperative clinical feature was pain (99.2%). The calculated sensitivity for ultrasound to accurately diagnose an interdigital neuroma was 83.6%, and to correctly locate neuroma was 79.5% respectively, which were both statistically different compared to clinical assessment (p value: <.001 and p value: <.001). The calculated sensitivity for MRI to accurately diagnose an interdigital neuroma was 93.6%, which was statistically different to clinical assessment (p value: .005). Preoperative clinical assessment has the highest sensitivity to accurately diagnose interdigital neuroma when compared to MRI and ultrasound. Preoperative clinical assessment has higher sensitivity to accurately locate interdigital neuroma when compared to ultrasound.
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Affiliation(s)
- Helena Franco
- Orthopaedic Surgery Department, Mater Hospital, Brisbane, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - Thomas Pagliaro
- Orthopaedic Surgery Department, Mater Hospital, Brisbane, Queensland, Australia
| | - Claudia Sparti
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Hp John Walsh
- Orthopaedic Surgery Department, Mater Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
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2
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Ortu S, Fiori E, Bagnoli I, Valente A, Pisanu F, Caggiari G, Doria C, Milano L. Complications of alcohol injections for Morton’s neuroma. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221116392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Morton’s neuroma (MN) is a neuropathic metatarsalgia that causes pain in the plantar aspect of the forefoot generally between the third and fourth metatarsal heads. Treatment can be nonoperative or surgical. Among nonoperative procedures, alcohol injections are still commonly used as considered simple, relatively safe and well-tolerated treatment. However, they present transient and minor complications. Methods Two hundred patients with a diagnosis of MN underwent ultrasound-guided injections with a 47.5% alcohol solution between 2013 and 2020. We reviewed the current literature to highlight the known complications of this treatment, comparing them to the complications developed by our patients. Results Three patients out of 200 patients, developed necrosis of skin and subcutaneous tissue not described in previous studies about MN. Conclusions Our study focuses attention on the complications subsequent to the alcohol injection therapy for MN. Patients and surgeons should be aware that in a small number of cases this therapy can be burdened by necrotic complications of the skin.
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Affiliation(s)
| | - Enrico Fiori
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Ignazio Bagnoli
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
| | - Angiola Valente
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
| | - Francesco Pisanu
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Gianfilippo Caggiari
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Carlo Doria
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Luigi Milano
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
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3
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Yorns WR. Neurologic Disorders Affecting the Foot and Ankle. Clin Podiatr Med Surg 2022; 39:15-35. [PMID: 34809793 DOI: 10.1016/j.cpm.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The neurologic causes of foot and leg dysfunction are reviewed. Disorders causing foot and ankle pain, weakness, or other sensorimotor disturbances often cause difficulty with ambulation and prompt patients to seek medical evaluation. Physical signs and symptoms along with targeted diagnostic testing are needed to come to the correct diagnosis and treatment plan. An overview of peripheral nerve, muscle, and central nervous system disorders affecting the foot and leg are discussed.
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Affiliation(s)
- William R Yorns
- Department of Neurology, UCONN School of Medicine, Connecticut Children's Medical Center, 505 Farmington Avenue., 2nd Floor, Farmington, CT 06032, USA.
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4
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Yang B, Mallett S, Takwoingi Y, Davenport CF, Hyde CJ, Whiting PF, Deeks JJ, Leeflang MMG, Bossuyt PMM, Brazzelli MG, Dinnes J, Gurusamy KS, Jones HE, Lange S, Langendam MW, Macaskill P, McInnes MDF, Reitsma JB, Rutjes AWS, Sinclair A, de Vet HCW, Virgili G, Wade R, Westwood ME. QUADAS-C: A Tool for Assessing Risk of Bias in Comparative Diagnostic Accuracy Studies. Ann Intern Med 2021; 174:1592-1599. [PMID: 34698503 DOI: 10.7326/m21-2234] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Comparative diagnostic test accuracy studies assess and compare the accuracy of 2 or more tests in the same study. Although these studies have the potential to yield reliable evidence regarding comparative accuracy, shortcomings in the design, conduct, and analysis may bias their results. The currently recommended quality assessment tool for diagnostic test accuracy studies, QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2), is not designed for the assessment of test comparisons. The QUADAS-C (Quality Assessment of Diagnostic Accuracy Studies-Comparative) tool was developed as an extension of QUADAS-2 to assess the risk of bias in comparative diagnostic test accuracy studies. Through a 4-round Delphi study involving 24 international experts in test evaluation and a face-to-face consensus meeting, an initial version of the tool was developed that was revised and finalized following a pilot study among potential users. The QUADAS-C tool retains the same 4-domain structure of QUADAS-2 (Patient Selection, Index Test, Reference Standard, and Flow and Timing) and comprises additional questions to each QUADAS-2 domain. A risk-of-bias judgment for comparative accuracy requires a risk-of-bias judgment for the accuracy of each test (resulting from QUADAS-2) and additional criteria specific to test comparisons. Examples of such additional criteria include whether participants either received all index tests or were randomly assigned to index tests, and whether index tests were interpreted with blinding to the results of other index tests. The QUADAS-C tool will be useful for systematic reviews of diagnostic test accuracy addressing comparative questions. Furthermore, researchers may use this tool to identify and avoid risk of bias when designing a comparative diagnostic test accuracy study.
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Affiliation(s)
- Bada Yang
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands (B.Y., M.M.L.)
| | - Sue Mallett
- UCL Centre for Medical Imaging, University College London, London, United Kingdom (S.M.)
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, and National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham, Birmingham, United Kingdom (Y.T., C.F.D., J.J.D.)
| | - Clare F Davenport
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, and National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham, Birmingham, United Kingdom (Y.T., C.F.D., J.J.D.)
| | - Christopher J Hyde
- Exeter Test Group, The Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, United Kingdom (C.J.H.)
| | - Penny F Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom (P.F.W.)
| | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, and National Institute for Health Research Birmingham Biomedical Research Centre, University Hospitals Birmingham National Health Service Foundation Trust and University of Birmingham, Birmingham, United Kingdom (Y.T., C.F.D., J.J.D.)
| | - Mariska M G Leeflang
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands (B.Y., M.M.L.)
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Affiliation(s)
- T Pelly
- Kingston Hospital, London, UK
| | - T Holme
- St George's Hospital, London, UK
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Frush K, Niester A. Revision of Recurrent Neuromas. Clin Podiatr Med Surg 2020; 37:521-532. [PMID: 32471616 DOI: 10.1016/j.cpm.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Forefoot neuromas are a common pathology that is seen in a wide variety of patients. Although conservative treatment is successful with modification of shoes/inserts or injections, surgical intervention is occasionally needed to alleviate the discomfort. Most surgical procedures for neuromas have a good outcome. There are times when the outcome is not optimal and revision surgery may be needed. This article describes revision surgery techniques that may lead to an improved outcome. Also discussed is the opportunity to reduce recurrence through the understanding of neuroma biology, diagnosis, and treatment options.
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Affiliation(s)
- Katherine Frush
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA.
| | - Amanda Niester
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA
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Delzell PB, Tritle BA, Bullen JA, Chiunda S, Forney MC. Clinical Utility of High-Frequency Musculoskeletal Ultrasonography in Foot and Ankle Pathology: How Ultrasound Imaging Influences Diagnosis and Management. J Foot Ankle Surg 2018; 56:735-739. [PMID: 28479161 DOI: 10.1053/j.jfas.2017.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Indexed: 02/03/2023]
Abstract
The use of high-frequency (high-resolution) musculoskeletal ultrasonography is increasing and has shown promising utility in many areas of medicine. The utility of musculoskeletal ultrasonography for foot and ankle complaints has not been widely investigated, however. Although some conditions of the foot and ankle are easily diagnosed by physical examination, others can have nonspecific examination findings, making optimal treatment decisions difficult. We hypothesized that high-resolution musculoskeletal ultrasound scanning of the foot and ankle can affect the diagnosis and/or treatment for patients presenting with foot or ankle complaints. Retrospectively, the cases of 98 patients who had undergone musculoskeletal ultrasound scanning of the foot or ankle were reviewed. The pre-ultrasound clinical diagnosis and treatment were compared with the post-ultrasound diagnosis and treatment. In 64% of the patients, the diagnosis or treatment changed after the ultrasound examination. In 43% of patients, both the diagnosis and the treatment changed after ultrasound scanning. For those patients for whom the diagnosis and treatment were unchanged after the ultrasound examination, the ultrasound findings were concordant with the pre-ultrasound clinical diagnosis for 100% of the patients. These results suggest that in a large proportion of patients, high-resolution musculoskeletal ultrasonography of the foot or ankle can facilitate appropriate diagnosis and management.
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Affiliation(s)
- Patricia B Delzell
- Assistant Professor of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Benjamin A Tritle
- Assistant Professor of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Jennifer A Bullen
- Biostatistician, Quantitative Health Services, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Stella Chiunda
- Clinical Assistant Professor of Surgery, Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Michael C Forney
- Assistant Professor of Radiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH.
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Abstract
Running is one of the most popular sports worldwide, with running events attracting hundreds of thousands of runners of all age groups. Running is an effective way to improve health but is also associated with a high risk of injuries. Up to 50% of regular runners report having more than one injury each year. Some injuries are caused by an accident but most are caused by overuse. The most frequent diagnoses are patellofemoral pain syndrome, tibial stress syndrome (shin splint), Achilles tendinopathy, iliotibial band friction syndrome (runner's knee), plantar fasciitis and stress fractures of the metatarsals and tibia. The knee is the most frequently injured joint in runners at all distances. Hamstring injuries are typically acute resulting in a sudden, sharp pain in the posterior thigh. Hip injuries are less common but it can be more difficult to make the correct diagnosis and treatment is more complex. Clinicians confronted by runners with shin pain must distinguish between stress fractures of the tibia, tibial stress syndrome (shin splints) and chronic exertional compartment syndrome. Foot and ankle injuries are the most common injuries reported by long distance and marathon runners. Excess body weight and the number of kilometers run per week are high risk factors for injuries. The roles of other factors, such as shoes, stretching and biomechanics are less clear. A detailed anamnesis and physical examination are important for the correct diagnosis or the necessity for further diagnostic imaging and subsequent therapy.
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Dando C, Cherry L, Jones L, Bowen C. The clinical diagnosis of symptomatic forefoot neuroma in the general population: a Delphi consensus study. J Foot Ankle Res 2017; 10:59. [PMID: 29299065 PMCID: PMC5745595 DOI: 10.1186/s13047-017-0241-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/11/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is limited evidence for defining what specific method or methods should be used to clinically influence clinical decision making for forefoot neuroma. The aim of this study was to develop a clinical assessment protocol that has agreed expert consensus for the clinical diagnosis of forefoot neuroma. METHODS A four-round Delphi consensus study was completed with 16 expert health professionals from either a clinical or clinical academic background, following completion of a structured literature review. Clinical experience ranged from 5 to 34 years (mean: 19.5 years). Consensus was sought on the optimal methods to achieve the clinical diagnosis of forefoot neuroma. Round 1 sought individual input with an open ended question. This developed a list of recommendations. Round 2 and 3 asked the participants to accept or reject each of the recommendations in the list in relation to the question: "What is the best way to clinically diagnose neuroma in the forefoot?" Votes that were equal to or greater than 60% were accepted into the next round; participant's votes equal to or less then 20% were excluded. The remaining participant's votes between 20 to 60% were accepted and placed into the following round for voting. Round 4 asked the participants to rank the list of recommendations according to the strength of recommendation they would give in relation to the question: "What is the best way to clinically diagnose neuroma in the forefoot?" The recruitment and Delphi rounds were conducted through email. RESULTS In round 1, the 16 participants identified 68 recommendations for the clinical diagnosis of forefoot neuroma. In round 2, 27 recommendations were accepted, 11 recommendations were rejected and 30 recommendations were assigned to be re-voted on. In round 3, 36 recommendations were accepted, 22 recommendations were rejected and 11 recommendations were assigned to be re-voted on. In round 4, 21 recommendations were selected by the participants to form the expert derived clinical assessment protocol for the clinical diagnosis of forefoot neuroma. From these 21 recommendations, a set of themes were established: location of pain, non weight bearing sensation, weight bearing sensation, observations, tests and imaging. CONCLUSION Following the identification of 21 method recommendations, a core set of clinical diagnostic methods have been prepared as a clinical assessment protocol for the diagnosis of forefoot neuroma. Based on expert opinion, the core set will assist clinicians in forming a clearer diagnosis of forefoot neuroma.
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Affiliation(s)
- Charlotte Dando
- University of Southampton and Solent NHS Trust, Southampton, UK
| | - Lindsey Cherry
- NIHR Clinical Lecturer in Podiatric Rheumatology, University of Southampton, Southampton and Solent NHS Trust, Southampton, UK
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10
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Percutaneous alcohol injection under sonographic guidance in Morton’s neuroma: follow-up in 220 treated lesions. Radiol Med 2016; 121:597-604. [DOI: 10.1007/s11547-016-0622-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
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11
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Nouh MR, Abd El-Gawad EA, Abdulsalam SM. MRI utility in patients with non-traumatic metatarsalgia: A tertiary musculoskeletal center observational study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Henderson REA, Walker BF, Young KJ. The accuracy of diagnostic ultrasound imaging for musculoskeletal soft tissue pathology of the extremities: a comprehensive review of the literature. Chiropr Man Therap 2015; 23:31. [PMID: 26543553 PMCID: PMC4634582 DOI: 10.1186/s12998-015-0076-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 10/16/2015] [Indexed: 12/17/2022] Open
Abstract
Musculoskeletal diagnostic ultrasound imaging (MSK-DUSI) has been growing outside the traditional radiology speciality. Increased use of this technology has been reported in several healthcare settings, however an apparent gap in the knowledge of the accuracy of this diagnostic technology indicated a review was warranted. We undertook a structured review of the literature to assess the accuracy of MSK-DUSI for the diagnosis of musculoskeletal soft tissue pathology of the extremities. An electronic search of the National Library of Medicine’s PubMed database (1972 to mid-2014) was conducted. All relevant systematic reviews of diagnostic studies, all diagnostic studies published after the date of the latest systematic reviews and relevant diagnostic studies outside the scope the systematic reviews that directly compared the accuracy of MSK-DUSI (the index test) to an appropriate reference standard for the target condition were included. A fundamental appraisal of the methodological quality of studies was completed. The individual sensitivity, specificity and likelihood ratio data were extracted and entered into diagnostic accuracy tables. A total of 207 individual studies were included. The results show that MSK-DUSI has acceptable diagnostic accuracy for a wide spectrum of musculoskeletal conditions of the extremities. However, there is a lack of high quality prospective experimental studies in this area and as such clinicians should interpret the results with some caution due to the potential for overestimation of diagnostic accuracy.
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Affiliation(s)
- Rogan E A Henderson
- Private Practice of Chiropractic, Spearwood, WA Australia ; 253 Winterfold Road, Coolbellup, 6163 WA Australia
| | - Bruce F Walker
- Associate Professor, Discipline of Chiropractic, School of Health Professions, Murdoch University, Murdoch, WA Australia
| | - Kenneth J Young
- Senior Lecturer, Discipline of Chiropractic, School of Health Professions, Murdoch University, Murdoch, WA Australia
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Drakonaki EE, Allen GM, Watura R. Ultrasound-guided intervention in the ankle and foot. Br J Radiol 2015; 89:20150577. [PMID: 26537692 DOI: 10.1259/bjr.20150577] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In this comprehensive review, we discuss the main interventions performed in the foot and ankle for Achilles tendinopathy, Morton's neuromas and Plantar fasciitis as well as techniques for intra-articular and peritendinous injections. We present the different imaging techniques and injectable agents that can be used in clinical practice, trying to help the reader decide the most appropriate way of managing the patient with a problem in the ankle and foot.
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Affiliation(s)
| | - Gina M Allen
- 2 Department of Radiology, Oxford University Hospitals NHS Trust and St Lukes Radiology, Oxford, UK
| | - Roland Watura
- 3 Department of Radiology, North Bristol NHS Trust, Bristol, UK
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Rehmani R, Endo Y, Bauman P, Hamilton W, Potter H, Adler R. Lower Extremity Injury Patterns in Elite Ballet Dancers: Ultrasound/MRI Imaging Features and an Institutional Overview of Therapeutic Ultrasound Guided Percutaneous Interventions. HSS J 2015; 11:258-77. [PMID: 26788031 PMCID: PMC4712185 DOI: 10.1007/s11420-015-9442-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 03/20/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Altered biomechanics from repetitive microtrauma, such as long practice hours in en pointe (tip of the toes) or demi pointe (balls of the feet) predispose ballet dancers to a multitude of musculoskeletal pathologies particularly in the lower extremities. Both ultrasound and magnetic resonance imaging (MRI) are radiation-sparing modalities which can be used to confidently evaluate these injuries, with ultrasound (US) offering the added utility of therapeutic intervention at the same time in experienced hands. QUESTIONS/PURPOSES The purposes of this paper were: (1) to illustrate the US and MRI features of lower extremity injury patterns in ballet dancers, focusing on pathologies commonly encountered at a single orthopedic hospital; (2) to present complementary roles of both ultrasound and MRI in the evaluation of these injuries whenever possible; (3) to review and present our institutional approach towards therapeutic ultrasound-guided interventions by presenting explicit cases. METHODS Online searches were performed using the search criteria of "ballet biomechanics" and "ballet injuries." The results were then further narrowed down by limiting articles published in the past 15 years, modality (US and MRI), anatomical region (foot and ankle, hip and knee) and to major radiology, orthopedics, and sports medicine journals. RESULTS Performing ballet poses major stress to lower extremities and predisposes dancer to several musculoskeletal injuries. These can be adequately evaluated by both US and MRI. US is useful for evaluating superficial structures such as soft tissues, tendons, and ligaments, particularly in the foot and ankle. MRI provides superior resolution of deeper structures such as joints, bone marrow, and cartilage. In addition, US can be used as a therapeutic tool for providing quick symptomatic improvement in these athletes for who "time is money". CONCLUSION Performing ballet may cause major stress to the lower extremities, predominantly affecting the foot and ankle, followed by the knee and hip. US and MRI play complementary roles in evaluating various orthopedic conditions in ballet dancers, with US allowing for dynamic evaluation and guidance for interventions.
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Affiliation(s)
- Razia Rehmani
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Yoshimi Endo
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Phillip Bauman
- />Orthopedic Associates of New York, 315 West 57th Street, New York, NY 10019 USA
| | - William Hamilton
- />Orthopedic Associates of New York, 315 West 57th Street, New York, NY 10019 USA
| | - Hollis Potter
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Ronald Adler
- />Hospital for Joint Diseases, New York University, New York, NY USA
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Bignotti B, Signori A, Sormani MP, Molfetta L, Martinoli C, Tagliafico A. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol 2015; 25:2254-62. [PMID: 25809742 DOI: 10.1007/s00330-015-3633-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/08/2014] [Accepted: 01/21/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton's neuroma. METHODS Studies that assessed the diagnostic accuracy of US and MRI for Morton's neuroma were retrieved from major medical libraries independently by two reviewers up to 1 April 2014. Predefined inclusion and exclusion criteria were adopted. RESULTS 277 studies were initially found, and the meta-analysis was conducted on 14 studies. US sensitivity was studied in five studies, MRI sensitivity in three studies, and bothin six studies. All studies used surgery as the reference standard. A high sensitivity (SE) of diagnostic testing was observed for both US (SE (95 % CI) = 0.91 (0.83-0.96)) and MRI (SE (95 % CI) = 0.90 (0.82-0.96)) with no significant differences between the two modalities in diagnosis (Q test p = 0.88). For MRI, specificity of test was 1.00 with a pooled estimation of 1.00 (0.73-1.00), while the pooled specificity was 0.854 (95 % CI: 0.41-1.00) for US. No differences were observed between US and MRI in study design (p = 0.76). CONCLUSION This meta-analysis shows that the SE of US (0.91) is equal to (p = 0.88) that of MRI (0.90) for identification of Morton's neuroma. KEY POINTS • For Morton's neuroma, US sensitivity is equal to MRI. • US is as accurate as MRI in diagnosing Morton's neuroma. • US may be the most cost-effective imaging method for Morton's neuroma.
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Affiliation(s)
- Bianca Bignotti
- Radiology Department, University of Genoa, Largo Rosanna Benzi 8, 16138, Genoa, Genova, Italy
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16
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Xu Z, Duan X, Yu X, Wang H, Dong X, Xiang Z. The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton's neuroma: a systematic review. Clin Radiol 2014; 70:351-8. [PMID: 25466436 DOI: 10.1016/j.crad.2014.10.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 02/05/2023]
Abstract
AIM To determine the accuracy of MRI versus ultrasound for Morton's neuroma. MATERIALS AND METHODS A search was undertaken for clinical studies published in any language in PubMed up to the date of December 2013. Studies assessing the accuracy of the ultrasound or MRI for the diagnosis of Morton's neuroma were included. Data were pooled for meta-analysis. Study selection, data collection, and extraction were performed independently by two authors. Meta-disc 1.4 and Revman 5.2 software were applied for statistical analysis. RESULTS The study included 12 studies; 217 patients underwent MRI and 241 underwent ultrasound examinations. There appeared greater diagnostic accuracy for ultrasound than MRI for the diagnosis of Morton's neuroma (ultrasound sensitivity 90%, specificity 88%, positive likelihood ratio 2.77, negative likelihood ratio 0.16 versus MRI sensitivity 93%, specificity 68%, positive likelihood ratio 1.89, negative likelihood ratio 0.19). CONCLUSIONS The available evidence suggests that ultrasound can provide better accuracy for the diagnosis of Morton's neuroma than MRI.
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Affiliation(s)
- Z Xu
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan, China
| | - X Duan
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan, China
| | - X Yu
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan, China
| | - H Wang
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan, China
| | - X Dong
- Department of Pathology, Chengdu Women's and Children's Central Hospital, No. 1617 Riyue Avenue, Chengdu 610000, Sichuan, China
| | - Z Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu 610041, Sichuan, China.
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Claassen L, Bock K, Ettinger M, Waizy H, Stukenborg-Colsman C, Plaass C. Role of MRI in detection of Morton's neuroma. Foot Ankle Int 2014; 35:1002-5. [PMID: 24958767 DOI: 10.1177/1071100714540888] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distinguishing between patients with a true Morton's neuroma and other forefoot pathology can be difficult. The aim of this study was to evaluate the diagnostic accuracy of routine magnetic resonance imaging (MRI) when compared to clinical examination for Morton's neuroma. METHODS We retrospectively identified 71 patients who underwent operative treatment due to the diagnosis of Morton's neuroma between 2007 and 2013. All patients had a MRI preoperative. Our study group comprised 58 female and 13 male patients with a mean age of 57 (range, 38-92) years. We compared the results of preoperative MRI and the patient's clinical assessment with postoperative histopathological results. RESULTS Typical clinical signs were found in 65 cases. Most common symptoms were plantar pain (92%) and increased pain on walking (89%). A Morton's neuroma was detected on MRI in 59 of 71 cases. Its sensitivity was 0.84 and its specificity was 0.33. The positive and negative predictive values were 0.97 and 0.08, respectively. For the presence of main clinical symptoms we found a sensitivity of 0.94 and a specificity of 0.33. The positive predictive value was 0.97 and the negative predictive value was 0.20. CONCLUSION MRI under routine conditions had a good detection rate for the evaluation of Morton's neuroma. However, its accuracy was not as high as the accuracy of clinical assessment. LEVEL OF EVIDENCE Level IV, retrospective series.
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Affiliation(s)
- Leif Claassen
- Hannover Medical School, Orthopedic department, Hannover, Germany
| | - Kilian Bock
- Hannover Medical School, Orthopedic department, Hannover, Germany
| | - Max Ettinger
- Hannover Medical School, Orthopedic department, Hannover, Germany
| | - Hazibullah Waizy
- Hessing Foundation, Clinic for Foot and Ankle Surgery, Augsburg, Germany
| | | | - Christian Plaass
- Hannover Medical School, Orthopedic department, Hannover, Germany
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Abstract
Morton's neuroma is a common condition mainly affecting middle aged women, and there are many proposed etiological theories involving chronic repetitive trauma, ischemia, entrapment, and intermetatarsal bursitis. Incorrect terminology suggests that the underlying pathological process is a nerve tumor, although histological examination reveals the presence of inflammatory tissue-that is, perineural fibrosis. The common digital nerve and its branches in the third planter webspace are most commonly affected. Diagnosis is usually made through history taking and clinical examination but may be aided by ultrasonography and magnetic resonance imaging. Current nonoperative treatment strategies include shoe-wear modifications, custom made orthoses, and injections of local anesthetic agents, sclerosing agents, and steroids. Operative management options primarily involve either nerve decompression or neurectomy. We have reviewed the published literature to evaluate the outcomes of the available diagnostic modalities and treatment options and present an algorithm for clinical practice.
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Affiliation(s)
- Sameer Jain
- Department of Trauma & Orthopaedic Surgery, Scarborough General Hospital, Woodlands Drive, Scarborough, North Yorkshire, YO12 6QL, UK.
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