Relationship Between Sensory Symptoms, Mulder’s Sign, and Dynamic Ultrasonographic Findings in Morton’s Neuroma

Abstract

Background: Morton’s neuroma (MN) is often a diagnostic dilemma lacking a gold standard set of diagnostic criteria. Advanced imaging of MN is evolving including ultrasonography. The current study aimed to analyze the relationship between ultrasonographic findings and symptoms, clinical data, and operative findings in a subgroup of patients. Methods: We evaluated physical examination, ultrasonographic findings, symptoms, and in a subgroup, the operative findings for Morton’s neuroma. We analyzed the symptoms, the findings on physical examination, and ultrasonography data and performed a statistical correlation between them. A total of 175 patients were seen for suspected Morton’s neuroma during the last 7 years. Results: Neuropathic pain of the toes was reported in 63% of patients. Presence of ultrasonographic findings suggesting Morton’s neuroma was observed in 77% of cases. A mild significant relationship between neuropathic pain and positive ultrasonographic findings was observed. We found a strong correlation between ultrasonographic and clinical evaluation, but more than half with clinical negative Morton’s neuroma had positive findings at ultrasonography. In the subgroup of operatively treated patients (n = 44) surgery confirmed Morton’s neuroma in all patients who had positive ultrasonography findings. Conclusions: The current study suggests that the association of ultrasonographic evaluation and clinical evaluation can be very useful for the management of Morton’s neuroma. Our study could help with the development of a multiperspective approach in the diagnosis of Morton’s neuroma. Level of Evidence: Level II, prospective cohort survey study.