Foot (Edinburgh, Scotland) · 2025
The role of neuroma size in the management of Morton's neuroma.
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Vadera Sonam, Divall Pip, Bhatia Maneesh
Аннотация
BACKGROUND: Morton's neuroma is a common forefoot pathology characterised by fibrosis and thickening of the interdigital nerve in the intermetatarsal space. This scoping review aims to systematically map and summarise current evidence regarding the role of neuroma size in diagnosing and managing Morton's neuroma, with particular focus on correlations between symptom severity and treatment outcomes.
METHODS: Following the frameworks of Arksey and O'Malley, Levac, and Peters, this scoping review used a comprehensive search strategy to identify relevant studies across multiple databases. A two-stage screening process was conducted independently by two reviewers.
RESULTS: A total of 242 studies were identified, with 34 included for review. Both MRI and ultrasound were found to be effective in detecting neuromas, although definitions and diagnostic criteria varied. Findings on the correlation between neuroma size and symptom severity were mixed; larger neuromas were sometimes, but not consistently, associated with more severe symptoms. Treatment outcomes following steroid injections or surgical excision did not show a clear dependency on neuroma size, with mixed evidence across studies. Corticosteroid injections demonstrated variability in effectiveness based on neuroma size, while surgical outcomes showed no consistent correlation with neuroma size.
CONCLUSIONS: Despite the utility of imaging in diagnosing Morton's neuroma, clinical evaluation remains crucial, as neuroma size alone may not reliably predict symptoms or treatment response. Further research with standardised imaging criteria and extended follow-up is essential to better understand the relationship between neuroma size, symptom severity, and treatment outcomes, aiming to enhance treatment precision and efficacy.
METHODS: Following the frameworks of Arksey and O'Malley, Levac, and Peters, this scoping review used a comprehensive search strategy to identify relevant studies across multiple databases. A two-stage screening process was conducted independently by two reviewers.
RESULTS: A total of 242 studies were identified, with 34 included for review. Both MRI and ultrasound were found to be effective in detecting neuromas, although definitions and diagnostic criteria varied. Findings on the correlation between neuroma size and symptom severity were mixed; larger neuromas were sometimes, but not consistently, associated with more severe symptoms. Treatment outcomes following steroid injections or surgical excision did not show a clear dependency on neuroma size, with mixed evidence across studies. Corticosteroid injections demonstrated variability in effectiveness based on neuroma size, while surgical outcomes showed no consistent correlation with neuroma size.
CONCLUSIONS: Despite the utility of imaging in diagnosing Morton's neuroma, clinical evaluation remains crucial, as neuroma size alone may not reliably predict symptoms or treatment response. Further research with standardised imaging criteria and extended follow-up is essential to better understand the relationship between neuroma size, symptom severity, and treatment outcomes, aiming to enhance treatment precision and efficacy.