Saravana Vail Karuppiah*, Ali Bukhari and Anand Pillai
Department of Orthopedics and Musculoskeletal Disorders, University Hospital of South Manchester NHS Foundation Trust, UKFulltext PDF
Introduction: The diagnosis of Morton’s neuroma can be difficult with clinical assessment alone and may require further investigation. Radiological investigations add to help further confirm the diagnosis before offer of surgery. However the reliability of ultrasound have been reported quite variable in literature.
Aim: The objective of the study was to determine the reliability and effectiveness of Ultrasonography in diagnosis of the presence of Morton’s Neuroma (MN) by comparing it against histology findings.
Materials and Methods: All consecutive patients diagnosed with Morton’s Neuroma (MN) over a period of 5 years were identified using the hospital code. Fifty-five subjects and seventy intermetatarsal spaces were examined via Ultrasonography to detect neuroma. The retrospective ultrasound reports were then compared and correlated to histopathology findings. Both the ultrasound and histopathology reports were then used to evaluate the diameter of the neuroma.
Results: Seventy neuromas in 55 patients underwent surgery. All tissues were sent for histopathology examination and 60 were diagnosed positive for MN i.e. around 86% of the cases were correctly diagnosed for the presence of a neuroma using Ultrasonography. The sensitivity and specificity for ultrasound was 1.0 (95% CI range 0.925 to 1) and 0.3 (95% CI range 0.080 to 0.646) respectively.
The results show ultrasound being a very sensitive test for the diagnosis of MN. No significant comparison could be made to assess the diameter of each neuroma in both the sonographic and histopathology reports; this was due to inadequate data within the histopathology reports.
Discussion: The diagnosis of MN still remains a clinical diagnosis, which can be confirmed using radiological investigations. The sensitivity of Ultrasonography has been reported quite variable in literature and is primarily operator dependant. In our unit ultrasound is quicker to obtain and we anecdotally is quite reliable. Conclusion: Ultrasonography is a reliable and effective method to diagnose the presence and location of a Morton’s neuroma; however it is unreliable when assessing the size of a Morton’s neuroma.
Vail Karuppiah S, Bukhari A, Pillai A. Reliability of Ultrasonography in the Diagnosis of Morton’s Neuroma: A Comparison Study with Histology Results. Ann Orthop Musculoskelet Disord. 2019;2(1):1020.