Kim J-Young, Choi Jae Hyuck, Park Jungmin, Wang Joonho, Lee Inmook
Eulji Medical Center, Foot and Ankle Clinic, Department of Orthopaedics, Hagye 1-Dong, Nowon-Gu, Seoul, 139-711, Republic of Korea.
Foot Ankle Int. 2007 Sep;28(9):1007-10. doi: 10.3113/FAI.2007.1007.
Using clinical and cadaver studies, we examined the relationship between the location of Morton interdigital neuromas and the surrounding structures, including the deep transverse metatarsal ligament (DTML), which has been suspected as a major causative factor in neuroma formation.
Seventeen fresh-frozen cadavers were evaluated to determine the relationship between the location of Morton interdigital neuromas and the DTML at two phases of the gait cycle with 60 degrees of metatarsophalangeal dorsiflexion and with 15 degrees of ankle dorsiflexion. We measured the distance from the bifurcation of the common digital nerve in the foot to the anterior margin of the DTML and also measured the length of the DTML itself. Clinically, we checked the location of the Morton interdigital neuroma and its length during surgery in 32 feet.
In the second and third webspace, the mean distance from the bifurcation of the common digital nerve of the foot to the anterior margin of the DTML was 16.7 mm, 15.1 mm in the mid-stance position, and 15.9 mm and 14.6 mm in the heel-off position. The length of the second and third DTML averaged 12.8 mm and 10.6 mm. Clinically, all of the cases of Morton interdigital neuroma started at the bifurcation area of the common digital nerve, and the mean neuroma length was 7.5 mm (6 to 11).
Morton interdigital neuromas were located more distally than the DTML in both the mid-stance and the heel-off stage during walking. The main lesion was located between the metatarsal head and the metatarsophalangeal joint and more distal than the DTML, questioning previous studies suggesting that the DTML is the major causative factor in development of Morton interdigital neuroma.
通过临床研究和尸体研究，我们探讨了莫顿趾间神经瘤的位置与周围结构之间的关系，其中包括怀疑在神经瘤形成中起主要致病作用的跖骨深横韧带（DTML）。
对17具新鲜冷冻尸体进行评估，以确定在跖趾关节背屈60度和踝关节背屈15度这两个步态周期阶段，莫顿趾间神经瘤的位置与DTML之间的关系。我们测量了足部趾总神经分叉处到DTML前缘的距离，以及DTML本身的长度。在临床上，我们在32只脚上的手术过程中检查了莫顿趾间神经瘤的位置及其长度。
在第二和第三趾蹼间隙，足部趾总神经分叉处到DTML前缘的平均距离在站立中期为16.7毫米，足跟离地时分别为15.9毫米和14.6毫米。第二和第三跖骨深横韧带的长度平均分别为12.8毫米和10.6毫米。临床上，所有莫顿趾间神经瘤病例均始于趾总神经分叉区域，神经瘤平均长度为7.5毫米（6至11毫米）。
在行走的站立中期和足跟离地阶段，莫顿趾间神经瘤的位置比DTML更靠远端。主要病变位于跖骨头与跖趾关节之间，且比DTML更靠远端，这对之前认为DTML是莫顿趾间神经瘤发生的主要致病因素的研究提出了质疑。
