Mallet Toes, Hammertoes, Neuromas, and Metatarsophalangeal Joint Instability: 40 Years of Development in Forefoot Surgery.

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Abstract

Conflict of interest statement: Conflict of InterestThe senior author, MC, has consulting relationships with Stryker & Arthrex, whose implants are referenced in this paper. The lead author, DD has no conflicts of interest. 16. J Man Manip Ther. 2020 Feb;28(1):60-67. doi: 10.1080/10669817.2019.1611044. Epub 2019 Jun 9. Mechanical diagnosis and therapy and Morton's neuroma: a case-series. Post MD(1), Maccio JR(2). Author information: (1)Integrated Musculoskeletal Care, Inc, Tallahassee, FL, USA. (2)Maccio Physical Therapy, Troy, NY, USA. Objectives: Morton's neuroma (MN) is a neuralgia involving the common plantar digital nerves of the metatarsal region. Evidence-based treatment options for MN are sparse, and utility of physical therapy (PT) is unknown. Mechanical Diagnosis and Therapy (MDT) is a classification system utilizing direction-specific treatment for orthopedic conditions based on mechanical and symptomatic response to repeated end range movements. The purpose of this case series is to describe the management of three patients with a medical diagnosis of MN using the MDT classification system.Methods: Three female patients aged 54-75 years with unilateral plantar forefoot pain for 6 weeks to 8 years were referred by a podiatrist following positive clinically accepted diagnostic criteria for MN including radiological imaging and provocation testing. Patients were evaluated and treated utilizing MDT assessment and treatment principles. The intervention consisted of repeated movements matched to the patient's directional preference at either the lumbar spine (1 patient) or distal extremity (2 patients).Results: Immediate and one-year outcomes were excellent, demonstrating rapid and lasting improvement. Following discharge, the patients have been asymptomatic or able to self-manage without seeking additional medical intervention for this condition. Total visit frequency per patient averaged 2-3 visits total across 8-16 days.Discussion: Responses to repeated end range movements testing allowed for classification and prescription of exercise to rapidly improve symptoms and function in three patients referred to PT services with medically diagnosed MN. This series provides preliminary evidence that MDT may be effective in classifying and treating patients with MN. DOI: 10.1080/10669817.2019.1611044 PMCID: PMC7006749