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THE
CAUSATIVE
MECHANISM
J.
Several
articles
of Morton’s
neuroma
made
which
make
cure
Morton’s
it seems
(Betts
these
with
nor
while
attention
on the
sole
fourth
metatarsal
fingers
of the
of the
foot
left
at the
heads.
site
On
condition,
1943).
an
of the
that
But
foot
is clasped
of the
right
with
the
I
the
right
heads
by
hand,
the
metatarsal
be pinched
in which
with
pain
94
there
thumb
heads
this
mass
toes.
to
be felt
pushed
the
Indeed,
formation
one
a small
back
mass
between
the
or
many
times
feet
which
the
sole
a painful
tumour
more
with
by
escaping
is done
unstable
pressure
the
third
and
thumb
and
of
weight-
had
lateral
with
some
to
the
the
two
force,
sole
and
splayed
THE
JOURNAL
of the
subjective
out.
foot.
BONE
of the
mass
may
In the
case
pain
coincides
The
objective
sign-the
metatarsals
OF
metatarsal
the
characteristic
the
be
compression
it is pushed
the
than
metatarsal
firm
left
the
by
before
into
frequently
the
made
appears
to
has
been
bursa
the
2-The
be turned
Note
that
the
inter-
in between
foot
a neuroma,
in
a neuroma
is pressed
heads
these
be easily
exerts
It
bursa
to the
Figure
it to
seen.
from
neuroma
of the
compression
metatarsal
is formed
by the
many
of
of our patients
such
at a second
operation.
into
If this
caused
found
the
In
removed
fingers.
contains
click
sole.
pains
2
FIG.
avoid
the
can
for a moment
click-is
in the
bursa,
of
and
with
a palpable
sign-the
part
can
of the
neuroma
For
between
fingers
of the
of the
sharp
around
usually
has
been
mobilised
and
drawn
aside.
form
of the
intermetatarsal
bursa.
The
opened,
and
is seen
on the
medial
side of the tumour.
Medial
capsule
covering
the
third
metatarsal
bead
is partly
visible.
distal
connections
of the
neuroma
have
been
cut,
allowing
proximally.
The cleft
between
the metatarsal
heads
is clearly
the
plantar
nerve
should
be
divided
at least
1 centimetre
metatarsal
bearing
of the
sudden
hand
etiology
removal
origin
which
I-The
neuroma
the
plantar
wall
Figure
the
the
of one
the
of those
neuroma,
pressure
and
observations
thumb
suspected
with
a neuroma
innocent-disease.
patient’s
the
dealt
that
explanation
to two
while
alternating
FIG.
have
a crippling-though
lest-The
hand
years
clear
McElvenny
is there
such
to draw
recent
in this
metatarsalgia
worth
the
sufficiently
1940,
reports,
in every
case of Morton’s
disease.
First observation
: a diagnoslic
clinical
heads
of
made
finding
METATARSALGIA
NETHERLANDS
literature
been
is a constant
from
MORTON’S
AMSTERDAM,
orthopaedic
a radical
clear
MULDER,
It has
nerves
affords
is not
reasons
the
metatarsalgia.
digital
plantar
in
D.
IN
give
AND
JOINT
sudden
a more
SURGERY
or
THE
less
distinct
heads.
sensation
In
allows
CAUSATIVE
these
of pinching
weak
feet
displacement
heads
are
of
normally
the metatarsal
into the space
observalion-At
sole
and
found
to be
the
the
sole
the
when
plantar
and
surgeon’s
to the
wall
of
the
bursa
foot
is laid
it
out
by
and,
cannot
by
indeed,
be
the
same
gentle
removed
formation
fibrous
foregoing
pinching
plantar
with
weak
digital
Our
bands
observations
of the
associated
plantar
that
so intimately
without
has
it will
be
connected
opening
the
bursa
2).
of irregular
The
of the
click
dissection
If the bursa
is inspected
after removal
of the neuroma
it will appear
bear
the marks
of frequent
damage
to its fibrous
walls
in the form
to
incision
intermetatarsal
compression
the
to be
of
tissue
a longitudinal
lateral
by
metatarsal
approximation
of plantar
into
upon
removed
bursa
The
and
bare
is accompanied
is carefully
that
spaces.
pushed
metatarsal
weight-bearing
to displacement
easily
pressed
This
those
upon
separation
and
be
of the
spaces
into
bursa
can
intermetatarsal
the
the
afterwards
hand.
compression
Repeated
it
neuroma
lateral
neuroma
heads
If the
adherent
of
bursa.
95
METATARSALGIA
intermetatarsal
of this
metatarsal
above.
1 and
(Figs.
by
upon
of the
a small
to be pinched
heads
mentioned
with
the
is seen
been
from
by
operation,
between
metatarsal
tissue
MORTON’S
tissue
widening
heads
lead to enlargement
occupied
by the bursa.
in
space
IN
of soft
the
separated
Second
the
MECHANISM
and
transverse
artery
observations
that
between
may
also
are
based
the
the
neuroma
metatarsal
arches.
be
and
and
layers.
suggest
nerve
to be enlarged
of thickening
is caused
heads
According
caught
and
to
thereby
on operative
during
Nissen’s
included
findings
mechanically
by repeated
the
movements
abnormal
(1948)
in the
in twelve
observations,
the
tumour.
consecutive
cases
of Morton’s
disease.
DISCUSSION
Morton
(1 876)
metatarsal
suggested
heads
obscured
might
rather
that
be the
than
pinching
cause
cleared
of the
our
of the
plantar
pain.
Later
vision.
Even
nerve
Nissen’s
excellent
contributed
somewhat
to the confusion,
because
might
be due to ischaemia
and that
they
pointed
he suggested
to a primary
far,”
the
he added,
particularly
no reason
“
subject
original
4-5 but
opinion,
the 3-4,
mobility
and
into
by
swelling
and
been
found
degeneration.”
with
of the
a space
pinched
to
has
the
why
The
writer
qualification-in
sometimes
the
metatarsals,
giving
fibrous
reaction
test
of diagnostic
the
present
where
of the
around
the
nerve
pinching
nerves
heads.
and
of the
3-4
returns
takes
between
fifth
to tumour
nerve
So
“
to
are
Morton’s
it is not
place.
their
and vessels,
Repeated
leads
and
interspace
authors-that
bursa
the plantar
metatarsal
fourth
changes
in the
degeneration.
article
most
the
the
have,
for the most part,
and
extensive
study
that the
arterial
vessels
with
to widening
including
of the
in and
of
interspace
rise
which
plantar
tissue,
subsequent
movements
digital
agreement
2-3,
between
publications
heads,
the
Abnormal
creates
may enter,
to be
trauma
produces
formation.
SUMMARY
1
.
clinical
A
2.
Findings
3.
The
at
operation
causation
in
of the
significance
twelve
digital
in Morton’s
cases
are
neuroma
metatarsalgia
is described.
recorded.
is discussed.
REFERENCES
L.
BETTS,
0.
(1940)
: Medical
R.
(1943)
MCELVENNY,
MORTON,
T.
K.
NIS5EN,
WINKLER,
VOL.
33
G.
I.
(1876)
(1948)
NO.
1,
Journal
of Australia,
: Journal
: American
: Journal
FELTNER,
H.,
B,
T.
J.
FEBRUARY
of Bone
Journal
of Bone
B.,
and
1951
and
I, 514.
and
Joint
of the
Iedical
Joint
KIMMELSTIEL,
Surgery,
Surgery,
P.
25,
Sciences,
(1948)
30-B,
: Journal
675.
71,
37.
84.
of Bone
and
Joint
Surgery,
30-A,
496.