Musculoskeletal Diseases

All Conditions

Symptoms and General Pathology

Neoplasms

Nervous System Diseases

Skin and Connective Tissue Diseases

Bursitis

Pain

Metatarsalgia

Neuroma

Morton Neuroma

Nerve Sheath Neoplasms

Neoplasms, Nerve Tissue

Neoplasms by Histologic Type

Joint Diseases

Foot Diseases

Neuralgia

Peripheral Nervous System Diseases

Neuromuscular Diseases

Neurologic Manifestations

Patients with intermetatarsal pain have ultrasound and MRI done

Healthy individuals (no forefoot pain) undergo ultrasound and MRI scan of the forefoot.

MRI of the forefoot with contrast (Gadovist)

MRI with contrast

Ultrasound

Sif B Larsen, MD

The aim of this study is to investigate the incidence of intermetatarsal bursitis and Morton's neuroma in patients with metatarsalgia (i.e. pain in the forefoot) and control subjects by diagnostic imaging with ultrasound and MRI.

In a group of patients with intermetatarsal pain found by an orthopedic surgeon, the investigators want to assess the incidences of intermetatarsal bursitis and Morton's neuroma, using diagnostic imaging; ultrasound and MRI.

The hypothesis is, that intermetatarsal bursitis is an overlooked diagnosis in patients with metatarsalgia. As a result of sparse literature and lack of knowledge about this condition with symptoms mimicking Morton's neuroma, a part of patients diagnosed with Morton's neuroma, suffers from intermetatarsal bursitis instead.

Additionally, the investigators want to evaluate the clinical sign opening toes.

Based on clinical photos of the feet, the investigators want to document the presence of opening toes and investigate if there is a correlation with either intermetatarsal bursitis and/or Morton's neuroma.

This is a diagnostic study with a patient and a control group.

US and MRI of the Forefoot: Intermetatarsal Bursitis or Morton's Neuroma

Ultrasound and MRI of the Forefoot: Intermetatarsal Bursitis or Morton's Neuroma

High intensity on T2 weighted images, low signal on T1. Thin peripheral enhancement on T1 contrast enhanced pictures.

Hypoechoic mass between metatarsal heads closest to dorsal surface of foot. Compressible. Activity on power/color doppler.

Low to Intermediate signal in T1 and T2. Contrast enhancement of the nodular focus.

Hypoechoic mass between metatarsal heads closest to plantar surface of foot. Non-compressible. The interdigital nerve can be seen entering the mass. Close relation to the interdigital artery.

Other pathology than intermetatarsal bursitis or Morton's neuroma.

Presence of opening toes/V-sign/spreading toes.

The Danish Rheumatism Association

Hvidovre University Hospital

Bispebjerg Hospital

Gentofte Hospital

Rigshospitalet, Denmark

Principal Investigator

Neuritis

Anti-Arrhythmia Agents

Channel Blockers

Central Nervous System Depressants

All Drugs and Chemicals

Anti-Inflammatory Agents

Antineoplastic Agents

Antiemetics

Neuroprotective Agents

Gastrointestinal Agents

Lidocaine

Prednisolone

Methylprednisolone

Methylprednisolone Acetate

Methylprednisolone Hemisuccinate

Prednisolone acetate

Prednisolone hemisuccinate

Prednisolone phosphate

Anesthetics

Anesthetics, Local

Sodium Channel Blockers

Diuretics, Potassium Sparing

Glucocorticoids

Hormones

Hormone Antagonists

Protective Agents

Antineoplastic Agents, Hormonal

1 injection of 1mL methylprednisolone \[40mg\]with 1 mL 2% lignocaine

weekly manipulations to the metatarsophalangeal joints of the forefoot for 6 weeks

a single injection of 1 mL methylprednisolone \[40 mg\] and 1 mL 2% lignocaine

methylprednisolone

The lesser MTPJs of the affected foot will be manually manipulated using a high velocity, low amplitude thrust technique.

manual manipulation

David G Cashley, BSc(Hons)Pod

This study compares manipulative therapy to steroid injection in the treatment of Morton's Neuroma.

The aim of this study is to establish whether manipulative therapy is an effective treatment for Morton's neuroma, a nerve entrapment in the foot. Steroid injection is the current gold standard conservative treatment for this condition. Therefore, a subject group shall be compared to a steroid injection intervention group. Outcomes will be compared using visual analogue pain scales -VAS, Foot Function Index questionnaires and algometric pressure threshold testing. An improvement in the manipulation group VAS of 20mm above the injection group shall be considered as the minimum worthwhile change as this has been identified as the minimum clinically important difference in pain between treatment groups in visual analogue pain scales.

Morton's Neuroma: Manipulation Versus Steroid Injection

Manipulation Versus Steroid Injection in the Treatment of Morton's Neuroma

A questionnaire to establish subjects level of function, pain and mobility changes over time

Patient reported outcome measurement tool to measure changes in foot pain over time

Measuring changes in self reported pain over time. 100mm scale with anchored prompts of "no pain" at 0mm and "worst pain ever" at 100mm

Measuring changes in pressure tolerance over time. A meter which reads how much change in pressure a joint can withstand before it registers discomfort

Queen Margaret University

Dundee Podiatry Clinic

Steroid and lidocaine injection with cryoablation

Image (ultrasound and fluoroscopic guided) cryoablation will be performed of the Morton's neuroma after nerve block.

Cryoablation

Ultrasound and fluoroscopic guided nerve block.

Nerve block

Dotter Interventional Institute

Lori Russell

Claire Kaufman

Morton's neuroma is a benign thickening involving the plantar interdigital nerve, most common in middle aged women. Morton's neuroma is one of the most frequent diagnoses seen in the investigators podiatry clinic and is difficult to treat. These lesions cause a burning or shooting pain that can radiate to the toes, or an aching pain in the ball of the foot. The pain is exacerbated with activity and certain footwear greatly limits activity in the involved patient population. Morton's neuroma is first treated conservatively with orthotics. Patients may require further interventions such as steroid injections. The literature reports only a 30% long term resolution of pain with the steroid. Surgical resection has a reported 51-85% success rate with 14-21% rate of complication; recurrent pain, numbness/loss of sensation, and subsequent stump neuromas.

Cryoablation is well known to be efficacious for neuropathic pain and has recently been shown in two small studies to be safe and efficacious for treatment of Morton's neuroma. The investigators study will compare outcomes of cryoablation to corticosteroid injection in short- and long-term for treatment of Morton's neuroma that have failed conservative therapy.

Comparative Effectiveness of Cryoablation Versus Steroid and Lidocaine Alone for Treatment of Morton's Neuroma

Comparative Effectiveness of Cryoablation Using the ICE-Seed Cryoablation Needle With Steroid and Lidocaine Versus Steroid and Lidocaine Alone for Treatment of Morton's Neuroma

Will be evaluated using the SF-36 Quality of Life Survey

Will be evaluated using the visual analog scale with 0 as no pain and 10 as the word pain imaginable

Changes to the modified American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal--Interphalangeal Scale, higher score is less symptomatic

Changes in Neuroma Scale, higher score is less symptomatic

Monitoring for safety of the treatment arm

Oregon Health and Science University

Diseases and Abnormalities at or Before Birth

Flatfoot

Talipes Cavus

Clubfoot

Talipes

Equinus Deformity

Congenital Abnormalities

Foot Deformities

Foot Deformities, Congenital

Foot Deformities, Acquired

Lower Extremity Deformities, Congenital

Limb Deformities, Congenital

Musculoskeletal Abnormalities

The effect of unilateral morton neuroma on gait parameters and foot pressure distribution in patients with bilateral pes planus will be investigated. Foot pressure distributions and gait parameters of the patients; foot rotation, step length, stance phase percentage, swing phase percentage, cadence, velocity, rerefoot pressure, midfoot pressure and forefoot pressure will be recorded with Zebris FDM -T ( Force distiribution Measurement Treadmill ) system. Zebris is a name of company in German .

The effect of unilateral morton neuroma on gait parameters and foot pressure distribution in patients with bilateral pes cavus will be investigated. Foot pressure distributions and gait parameters of the patients; foot rotation, step length, stance phase percentage, swing phase percentage, cadence, velocity, rerefoot pressure, midfoot pressure and forefoot pressure will be recorded with Zebris FDM -T ( Force distiribution Measurement Treadmill ) system. Zebris is a name of company in German .

The spatio temporal gait parameters of the patients will be evaluated with Zebris (Zebris Medical Limited , Germany) FDM (Force Distribution Measurement ) treadmill system. The system has production of 3D motion analysis and force measurement technologies for biomechanics. When the treadmill is in static and dynamic condition, strong pressure distribution measurement will be taken.

Comparison of gait and foot pressure

The aim of our study is to compare the effect of Morton's neuroma in feet with pes planus and pes cavus on foot pressure and temporal and spatial gait parameters.

Comparison of the Effects of Morton's Neuroma on Foot Pressure Distribution and Gait Parameters in Pes Planus and Pes Cavus Patients

Foot rotation (degree), will be evaluated by Zebris (Zebris Medical Limited - Germany) FDM (Force distribution measurement ) System. Participants will walk barefoot on the Zebris FDM (Zebris Medical Limited, Germany) treadmill system. Aim of the system to assessment the angle between the longitudinal axis of the foot and the running direction. Negative value = inward rotation, positive value = outward rotation.Subtalar joint supination describes angulation in the negative direction and pronation describes the angulation in the positive direction.Unit of measure is degrees.

Step length (cm) will be evaluated by Zebris (Zebris Medical Limited -, Germany) FDM (Force distribution measurement ) System. Participants will walk barefoot on the Zebris FDM (Zebris Medical Limited, Germany) treadmill system. Aim of the system analyzes gait of the patients. Step length describes the distance between the heel contact of one side of the body and the heel contact of the contralateral side. Unit of measure is centimeter.

Stance phase percentage (%) will be evaluated by Zebris (Zebris Medical Limited -, Germany) FDM (Force distribution measurement ) System. Participants will walk barefoot on the Zebris FDM (Zebris Medical Limited, Germany) treadmill system. Stance phase percentage describes the phase of a gait cycle in which the foot has contact with the ground.The unit is expressed as a percentage.

Swing phase percentage (%) will be evaluated by Zebris (Zebris Medical Limited -, Germany) FDM (Force distribution measurement ) System. Participants will walk barefoot on the Zebris FDM (Zebris Medical Limited, Germany) treadmill system. Swing phase describes the phase of a gait cycle during which the foot has no contact with the ground. The unit is expressed as a percentage.

Cadence (steps/min) will be evaluated by Zebris (Zebris Medical -Limited -, Germany) FDM (Force distribution measurement ) System. Participants will walk barefoot on the Zebris FDM (Zebris Medical Limited, Germany) treadmill system. Cadence is steps/minute. It is defined as the step frequency.

Velocity will be evaluated by Zebris (Zebris Medical -Limited -, Germany) FDM (Force distribution measurement ) System. Participants will walk barefoot on the Zebris FDM (Zebris Medical Limited, Germany) treadmill system. The system measures average gait speed during the analyzed measuring interval. The unit is expressed as km/hr.

Foot pressure distiribution will be evaluated by Zebris (Zebris Medical -Limited -, Germany) FDM (Force distribution measurement ) System. Participants will walk barefoot on the Zebris FDM (Zebris Medical Limited, Germany) treadmill system. The system evaluate the average maximum values reached in N/cm² for the three zones: toes, mid-foot and heel.

The ages of the patients will be recorded in the evaluation form.

The weight of the patients will be recorded in the evaluation form in kilograms.

The height of the patients will be recorded in the evaluation form in meters.

The BMI of the patients will be recorded in the evaluation form in kg/m\^2

Acibadem University

Assistant Professor

Radiofrequency procedure prior to the removal of morton's neuroma.

* Radiofrequency Machine: Multilesion Generator 3 Channels TLG-10 STP.
* Temperature: 80-85ºC
* Time: 90 seconds
* Active needle size: 1 cm
* Number of Applications: 3
* Impedance: less than 550
* Ultrasound. General Electric Logic R7 with 12 Mgh probe.

Peripheral ablation of affected Morton´s Neuroma nerve endings by thermal dissipation by an electrode.

Radiofrequency

The purpose of this study is to perform a radiofrequency procedure prior to the removal of morton's neuroma. This procedure would be performed to check in which percentage of the nerve ablation has been performed, and whether the current protocol is performed correctly or parts of the nerve remain intact.

Performing a radiofrequency procedure prior to the removal of morton's neuroma. This procedure would be performed to check in which percentage of the nerve ablation has been performed, and whether the current protocol is performed correctly or parts of the nerve remain intact.

* Step 1: Visualize the needle on the long axis of the probe.
* Step 2: Neurostimulate
* Step 3: Deposit of 1-2cc of anesthetic and wait about 2 minutes.
* Step 4: we apply the continuous radiofrequency at that point and once done we change the position of the needle to more dorsal planes anatomically and we made 2 more applications (in this case we will no longer have neurostimulation because the patient will be anesthetized).

Radiofrequency Before to Surgical Removal of a Recalcitrant Morton´s Neuroma

Universidad de Extremadura

Doctor

Customized insole with metatarsal support

Insole

Placebo Insole

Objective: The aim of the present study was to assess the effectiveness of insole with metatarsal support on pain in patients with Morton's neuroma and the impact of this insole on function, load distribution in the plantar region, gait variables, quality of life and satisfaction with insole use.

Methods: A randomized, controlled, double-blind, clinical trial with intent-to-treat analysis. Seventy-two patients with Morton's neuroma were randomly allocated into a study group and control group. One week following the baseline evaluation, the study group received insole with metatarsal support made of ethyl vinyl acetate and the control group received a flat insole of the same material, color and density. The groups were evaluated after 6, 12 and 24 weeks of insole use. The following assessment parameters employed: pain when walking and at rest (END); quality of life (SF-36); foot function (FFI and FHSQ); six-minute walk test (6MWT) and foot pressure analysis using the AM Cube FootWalk Pro program.

Insole on Morton's Neuroma

Effectiveness of Insole on Morton's Neuroma

Measured by visual analogue scale from 0 cm to 10 cm

Measured by Foot function index questionnaire

Measured by Foot Health Status questionnaire

Measured by the distance in the six minute walking test

Measured by the Short Form -36 questionnaire

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Federal University of São Paulo

PT, MsC

Infections

Wounds and Injuries

Immune System Diseases

Communicable Diseases

Fractures, Bone

Hypersensitivity

Hallux Valgus

Bunion

Nails, Ingrown

Nail Diseases

Skin Diseases

Ropivacaine

Patient receiving a specific block of medial and lateral plantar nerves in order to preserve the calcaneal nerve

Specific injection of long duration local anesthetic in contact with medial and lateral plantar nerves.

Local anesthetic : Ropivacaine : 0,375% - 5 ml per nerve.

Specific block of medial and lateral plantar nerves

Sébastien Bloc, MD

Foot surgery is a painful surgery that is usually scheduled in outpatients. A good management of analgesia is the crucial point. Regional anesthesia (RA) is the gold standard, that provides good anesthesia and a long duration of analgesia. The sciatic nerve block (or its branches) is the most adapted analgesic technique.

Limitation of proximal sciatic block is the motor block of the ankle and results in the impossibility, for the patient, to walk during the early post-operative period. Distal block of the sciatic nerve (tibial and fibular nerve blocks), at the level of the ankle, has been proposed to maintain the mobility of the ankle, to make deambulation with crutches easier. Nevertheless, the lack of sensibility of the heel remains a limitation for early walking, even with adapted shoes (ie : Barouk).

A specific anesthesia of the distal part of the foot, respecting the heel, could be the best option to provide an early deambulation and a suitable analgesia.

Ultrasound identification and specific anesthesia of the branches supplying the distal part of the foot (medial and lateral plantar nerves) could meet this dual objective : good anesthesia and suitable analgesia for early deambulation.

This study is a feasibility study of a specific block of the plantar branches of the tibial nerve, to preserve the sensibility of the heel, in case of foot surgery. The safety of the procedure will be assessed according to the rate of postoperative dysesthesia.

Block of the medial and lateral plantar branches of the tibial nerve will be performed under the medial malleolar-calcaneal axis (MMCA) in order to preserve the calcaneal nerves.

Blocks of the deep peroneal nerve (DPN) and the superficial peroneal nerve (SPN) will be added to provide an adequate anesthesia.

Every block will be performed under Ultrasound using a 27-gauge, 5-cm, short bevel needle.

5 mL of 0.375% Ropivacaine will be injected for each block. The sensory blocks will be assessed by pinprick test and cold test every 10 minutes for 40 minutes in the following locations: Calcaneal nerves, Lateral plantar nerve and Medial plantar nerve.

The extent of sensory block will be graded as follows: 2: normal sensation; 1: decreased sensation; and 0: no sensation (complete block).

Feasibility of Specific Anesthesia of the Forefoot Preserving the Sensitivity of the Heel for Foot Surgery

Specific Block of the Plantar Branches of the Tibial Nerve Under Ultrasound for Foot Surgery : A Monocentric Pilot Study

Pinprick and cold test on the sole of the foot - Cartography of the sole - Ipsilateral versus Contralateral test Numeric Scale for Pin-Prick test and Cold test : 2: normal sensation, 1: decreased sensation, 0: total loss of sensation

Usage (or not) of an additional anesthetic procedure to perform the surgery

Numeric Rating Scale for Visualization : from 0 (very difficult) to 100 (very easy)

Numeric Rating Scale for Satisfaction : from 0 (very unsatisfied) to 100 (very satisfied)

Numeric Rating Scale for Pain : from 0 (no pain) to 100 (severe pain)

Questionnaire about toe mobility, foot sensitivity and potential sensory anomalies such as numbness, itching or tingling.

CMC Ambroise Paré

Triamcinolone

Triamcinolone Acetonide

Triamcinolone hexacetonide

Triamcinolone diacetate

Mepivacaine

Immunosuppressive Agents

Immunologic Factors

Enzyme Inhibitors

Percoutaneous blind injection in Morton neuroma by subcutaneous needle group 1 are going to be injected by an experimented orthopaedic surgeon based on anatomic landmark. There is no internal control of the needle placement.

Mixture of 1 cc of 2% mepivacaine (Mepivacaina Normon 2%® )+ 40 mg of triamcinolone (Trigon Depot®) in each of the web spaces affected with Morton neuroma is injected.

Up to 4 injections are allow in the first three months of follow-up

1 cc of 2% mepivacaine (Mepivacaina Normon 2%® )+ 40 mg of triamcinolone (Trigon Depot®) in each of the web spaces affected with Morton neuroma is injected.

Up to 4 injections are allow in the first three months of follow-up

40 mg of triamcinolone (Trigon Depot®) in each of the web spaces affected with Morton neuroma is injected. Up to 4 injections are allow in the first three months of follow-up

US guided injection in Morton neuroma by subcutaneous needle. group 2 are going to be injected by an experimented musculoskeletal radiologist under ultrasound guidance. There is internal control of needle placement by ultrasound.

2% mepivacaine (Mepivacaina Normon 2%® ) in each of the web spaces affected with Morton neuroma is injected.

Up to 4 injections are allow in the first three months of follow-up

Introduction of a needle based in anatomical landmark

blind injection of Morton neuroma

blind injection of 1 cc of Mepivacaine Normon 2% ®

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
US and MRI of the Forefoot: Intermetatarsal Bursitis or Morton's Neuroma	NCT05685160	Intermetatarsal... Morton Neuroma Intermetatarsal...	MRI with contra... Ultrasound	18 Years -	Rigshospitalet, Denmark
Morton's Neuroma: Manipulation Versus Steroid Injection	NCT05707572	Morton Neuroma	methylprednisol... manual manipula...	18 Years -	Dundee Podiatry Clinic
Comparative Effectiveness of Cryoablation Versus Steroid and Lidocaine Alone for Treatment of Morton's Neuroma	NCT05501262	Morton Neuroma	Cryoablation Nerve block	18 Years - 105 Years	Oregon Health and Science University
Comparison of the Effects of Morton's Neuroma on Foot Pressure Distribution and Gait Parameters in Pes Planus and Pes Cavus Patients	NCT05012488	Morton Neuroma Pes Planus Pes Cavus	Comparison of g...	18 Years -	Acibadem University
Radiofrequency Before to Surgical Removal of a Recalcitrant Morton´s Neuroma	NCT05550831	Morton Neuroma Radriofrequency	Radiofrequency	18 Years - 70 Years	Universidad de Extremadura
Insole on Morton's Neuroma	NCT03511677	Morton Neuroma	Insole Placebo Insole	18 Years -	Federal University of São Paulo
Morton's Neuroma: Manipulation Versus Steroid Injection	NCT05707572	Morton Neuroma	methylprednisol... manual manipula...	18 Years -	Dundee Podiatry Clinic
Morton's Neuroma: Manipulation Versus Steroid Injection	NCT05707572	Morton Neuroma	methylprednisol... manual manipula...	18 Years -	Dundee Podiatry Clinic
Feasibility of Specific Anesthesia of the Forefoot Preserving the Sensitivity of the Heel for Foot Surgery	NCT03504462	Hallux Valgus a... Morton Neuroma Metatarsal Frac... Ingrown Nail Foot Wound Foot Infection	Specific block ...	18 Years -	CMC Ambroise Paré
Comparative Effectiveness of Cryoablation Versus Steroid and Lidocaine Alone for Treatment of Morton's Neuroma	NCT05501262	Morton Neuroma	Cryoablation Nerve block	18 Years - 105 Years	Oregon Health and Science University
Morton's Neuroma: Manipulation Versus Steroid Injection	NCT05707572	Morton Neuroma	methylprednisol... manual manipula...	18 Years -	Dundee Podiatry Clinic
Blind and Ultrasound Guided Injection in Morton Neuroma	NCT03046108	Morton Neuroma	blind injection... blind injection... blind injection... ultrasound guid... guided injectio... guided injectio...	18 Years -	Complejo Hospitalario Universitario de Granada

Spots Global Cancer Trial Database for morton neuroma