Stuart Lance Cohen MD, Presenter: Nothing to Disclose

Theodore T. Miller MD, Abstract Co-Author: Nothing to Disclose

Edward F DiCarlo, Abstract Co-Author: Nothing to Disclose

Scott J Ellis, Abstract Co-Author: Consultant, Integra LifeSciences Holdings Corporation Educator, Integra LifeSciences Holdings Corporation Consultant, OrthoHelix Surgical Designs, Inc

Matthew Roberts MD, Abstract Co-Author: Nothing to Disclose

To correlate the appearance of preoperative ultrasounds of Morton’s neuromas with the surgical specimens.

Nine Morton’s neuromas excised between July, 2013 and March, 2014 that had preoperative ultrasounds were evaluated with approval of the IRB. Preoperative ultrasounds were evaluated for neuroma size and appearance. The resected surgical specimens were sonographically evaluated for size and appearance immediately following excision. All pre- and postoperative scans were performed using Philips IU-22 scanners. Specimens were then evaluated pathologically. The appearance and size of the neuromas were compared between the preoperative and postoperative images, and were correlated to the surgical and pathologic appearances.

All specimens were pathologically proven as Morton’s neuromas; they showed focal thickening of the nerve at gross examination, and sclerosis and mucoid degeneration of the nerve fascicles and fibrotic thickening of the perineurium histologically. Longitudinal sonography of the specimens demonstrated echogenic focal enlargement of the nerve at the site of the neuroma, measuring 6.9 mm average (range 4 mm to 11 mm). Preoperative images in the longitudinal plane showed a normal fibrillar echogenic nerve extending to a focal heterogenous hypoechoic mass within the webspace which measured 14.3 mm average (range 9 mm to 24 mm). Surgically, all cases had thickened or scarred bursal tissue around the nerve, and interdigital vessels that had to be disentangled from the nerve.

The heterogenous hypoechoic intermetatarsal mass that is sonographically considered a “Morton’s neuroma” is actually a “neuroma-bursal complex” consisting of the thickened nerve, tangled vessels, and scarred/thickened bursa, that is much larger than the neuroma itself.  

Sonographically, Morton’s neuromas are actually neuroma-bursal complexes, larger than the neuroma itself.

Cohen, S, Miller, T, DiCarlo, E, Ellis, S, Roberts, M, Ultrasound of Morton’s Neuroma: What Are We Really Looking At?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045686.html