Morton's neuroma pathophysiology: Difference between revisions

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==Pathophysiology==
==Pathophysiology==
===Pathogenesis===
===Pathogenesis===
*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's neuroma is associated with 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
===Location===
===Location===
*Morton neuroma is characterized by being located at the:
*Morton neuroma is characterized by being located at the:
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**Epineural and endoneural arterial thickening/vascular hyalinization
**Epineural and endoneural arterial thickening/vascular hyalinization
**Degenerated/demyelinated axons
**Degenerated/demyelinated axons
[[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]]]
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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 -- 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]]]
 
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[[File:Morton neuroma -- 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_--_intermed_mag.jpg]]]
[[File:Morton neuroma -- 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_--_intermed_mag.jpg]]]

Revision as of 20:05, 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

Pathogenesis

  • Morton's neuroma is associated with 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

Location

  • 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

Gross pathology

Histopathology

  • 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, very 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, Intermediate magnification [6]
H&E stain of Morton's neuroma, High 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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