Morton's neuroma pathophysiology: Difference between revisions

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Neuroma
Neuroma


==Pathogenesis==
==Pathophysiology==
*The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Symptomatic collapse of the transverse arch by perineural [[fibrosis]] around a plantar digital nerve of the foot due to traction and increased pressure/chronic compression on the interdigital nerve
*Morton neuroma is characterized by being located in the 3rd web-space, between 3rd and 4th [[Metatarsals|metatarsal]] heads,<ref>{{cite book | last = Perry | first = Arie | title = Practical surgical neuropathology : a diagnostic approach | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0443069826 }}</ref> or sometimes in the second or fourth interspaces
*Morton neuroma is characterized by being located at the:
*On gross pathology, characteristic findings of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
** Third intermetatarsal space most commonly (between third and fourth metatarsals)<ref>{{cite book | last = Perry | first = Arie | title = Practical surgical neuropathology : a diagnostic approach | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0443069826 }}</ref>
** Second or fourth interspaces
** Bifurcation of the fourth plantar digital nerve
*On gross pathology, characteristic findings of morton's neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
**Adherent fibrofatty tissue
**Adherent fibrofatty tissue
**Small, firm, [[oval]], yellowish-white, [[Slow|slowly]] [[Growth|growing]], [[palpable]] [[nodule]] on [[skin]] (no discoloration of [[skin]] on the top of [[nodule]])
**Small, firm, [[oval]], yellowish-white, [[Slow|slowly]] [[Growth|growing]], [[palpable]] [[nodule]] on [[skin]] (no discoloration of [[skin]] on the top of [[nodule]])
**</=2cm in [[Size consistency|size]]
**</=2cm in [[Size consistency|size]]
*On microscopic histopathological analysis, characteristic findings of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*On microscopic histopathological analysis, characteristic findings of morton's neuroma include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
**Extensive fibrosis around and within the nerve
**Extensive fibrosis around and within the nerve
**Digital artery
**Digital artery
**[[Thrombosis]]
**[[Thrombosis]]
**Arterial thickening
**Epineural and endoneural arterial thickening/vascular hyalinization
*On histopathology, it is comprised of:
**Degenerated/demyelinated axons
**Degenerated/demyelinated axons
**Vascular hyalinization
**Fibrosis


[[File:Morton neuroma -- high mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, High magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_--_high_mag.jpg]]]
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[[File:Morton neuroma - alt 2 -- intermed mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, Intermediate magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_-_alt_2_--_intermed_mag.jpg]]]
[[File:Morton neuroma - alt 2 -- intermed mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, Intermediate magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_-_alt_2_--_intermed_mag.jpg]]]
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[[File:Morton neuroma -- high mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, High magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_--_high_mag.jpg]]]
 
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[[File:Morton neuroma -- very high mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, very high magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_--_very_high_mag.jpg]]]
[[File:Morton neuroma -- very high mag.jpg|thumb|200px|none| H&E stain of Morton's neuroma, very high magnification [https://commons.wikimedia.org/wiki/Category:Histopathology_of_Morton%27s_neuroma#/media/File:Morton_neuroma_--_very_high_mag.jpg]]]

Revision as of 20:01, 31 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [8]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[9]

Overview

Neuroma

Pathophysiology

  • Symptomatic collapse of the transverse arch by perineural fibrosis around a plantar digital nerve of the foot due to traction and increased pressure/chronic compression on the interdigital nerve
  • Morton neuroma is characterized by being located at the:
    • Third intermetatarsal space most commonly (between third and fourth metatarsals)[1]
    • Second or fourth interspaces
    • Bifurcation of the fourth plantar digital nerve
  • On gross pathology, characteristic findings of morton's neuroma, include:[2][3]
  • On microscopic histopathological analysis, characteristic findings of morton's neuroma include:[4][2][3]
    • Extensive fibrosis around and within the nerve
    • Digital artery
    • Thrombosis
    • Epineural and endoneural arterial thickening/vascular hyalinization
    • Degenerated/demyelinated axons
H&E stain of Morton's neuroma, High magnification [1]
H&E stain of Morton's neuroma, low magnification [2]
H&E stain of Morton's neuroma, High magnification [3]
H&E stain of Morton's neuroma, Intermediate magnification [4]
H&E stain of Morton's neuroma, Intermediate magnification [5]
H&E stain of Morton's neuroma, very high magnification [6]
H&E stain of Morton's neuroma, Intermediate magnification [7]

References

  1. ↑ Perry, Arie (2010). Practical surgical neuropathology : a diagnostic approach. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0443069826.
  2. ↑ 2.0 2.1 Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016
  3. ↑ 3.0 3.1 Wu J, Chiu DT (1999). "Painful neuromas: a review of treatment modalities". Ann Plast Surg. 43 (6): 661–7. PMID 10597831.
  4. ↑ Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016

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