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Foot & Ankle International 39(7)
Table 3. Peak Pressures (kPa) for 10 Masks and Pressure-Time Integrals (kPa · ms) for Metatarsals 2 to 4.a
M1PP
M2PP
M3PP
M4PP
M5PP
M6PP
M7PP
M8PP
M9PP
M10PP
M4PTI
M5PTI
M6PTI
MN Right
(n = 30)
Control Right
(n = 31)
P (95% CI)
MN Left
(n = 31)
Control Left
(n = 31)
342 ± 130
170 ± 58
298 ± 106
477 ± 174
461 ± 174
306 ± 99
227 ± 147
435 ± 213
206 ± 97
178 ± 69
153 ± 65
152 ± 69
108 ± 36
316 ± 73
156 ± 45
313 ± 127
494 ± 161
455 ± 151
297 ± 93
224 ± 124
454 ± 209
259 ± 360
151 ± 56
154 ± 48
146 ± 46
106 ± 33
.25 (−80 to 21)
.46 (−15 to 33)
.32 (−113 to 38)
.95 (−71 to 67)
.96 (−59 to 62)
.12 (−69 to 8)
.87 (−61 to 52)
.73 (−89 to 127)
.44 (−83 to 189)
.10 (−59 to 5)
.96 (−28 to 30)
.71 (−35 to 24)
.82 (−19 to 15)
357 ± 111
148 ± 51
366 ± 151
476 ± 121
437 ± 117
303 ± 86
216 ± 125
446 ± 238
173 ± 124
116 ± 55
154 ± 40
148 ± 42
109 ± 31
327 ± 86
157 ± 43
328 ± 146
474 ± 150
439 ± 122
272 ± 65
211 ± 96
448 ± 195
199 ± 82
152 ± 85
150 ± 48
143 ± 42
98 ± 26
P (95% CI)
.25 (−81 to 21)
.46 (−15 to 33)
.32 (−113 to 37)
.95 (−71 to 67)
.96 (−59 to 62)
.12 (−69 to 9)
.86 (−61 to 52)
.96 (−108 to 113)
.34 (−28 to 79)
.05 (−.37 to 72)
.72 (−27 to 19)
.65 (−26 to 17)
.10 (−26 to 3)
Abbreviations: CI, confidence interval; M1 (heel); M2 (midfoot); M3 (first metatarsal); M4 (second metatarsal); M5 (third metatarsal); M6 (fourth
metatarsal); M7 (fifth metatarsal); M8 (hallux); M9 (second toe); M10 (third, fourth, and fifth toes); MN, Morton's neuroma; PP, peak pressure; PTI,
pressure-time integral.
a
Data are expressed as mean ± SD.
were conducted using Power and Sample Size Calculation
version 3.0.43.13
Results
There were no significant differences in the peak pressures
of all masked areas and pressure-time integrals under metatarsal 2 to 4 heads between patients with MN and control
subjects (Table 3). However, contact time on the right heel
was reduced significantly in subjects with MN compared
with controls. Contact times were not significantly different
in all other masked areas (Table 4). In addition, no significant differences were observed between patients with MN
and control subjects in geometric measurements of forefoot
length, width, coefficient of spreading, foot progression
angle, and arch index (Table 4).
With power set to 80%, type I error 5%, and the minimum pooled standard deviation for each variable, retrospective calculations indicated that minimum detectable
differences were 21 kPa for peak pressure, 51 ms for contact time, 0.6 cm for foot length and width, 0.015 for coefficient of spreading, and 0.04 for arch index. These
minimum detectable differences increased as pooled standard deviations increased.
Discussion
Our study showed no significant differences in peak pressure and contact time between patients affected with MN
and control subjects in 10 masked areas of the foot. In addition, the pressure-time integrals over the second through
fourth metatarsal heads in subjects with neuromas were not
significantly increased compared with the control group.
This is in contrast with any suggestion that peak pressure
should increase in the forefoot in the immediate area of an
MN. Bauer et al6 believed that "hyperpressure" under the
metatarsals should be addressed for operative management
of MN. Bauer et al performed a retrospective study comparing open neurectomy (n = 26) and percutaneous deep transverse metatarsal ligament release with oblique osteotomy at
the level of the head of the affected metatarsal on patients
diagnosed with MN. They found that the short-term clinical
outcomes of the percutaneous osteotomy group were as
good as those of the open neurectomy group, with significantly better outcomes in the long term.6 A number of their
subjects had other associated conditions, such as hallux valgus, metatarsophalangeal joint subluxation, and toe deformities. MN can occur simultaneously in the presence of other
forefoot conditions. However, it is also important to note
that in patients with digital deformities, hallux valgus, systemic arthropathies, and neurological conditions, plantar
pressure in the forefoot can increase.9,12,18,29,39 However, all
our subjects had painful MN without any other forefoot
problems, which may explain why "hyperpressure" was
not significantly different between our MN and control
groups. In view of our results, if lesser metatarsal osteotomies are being considered as a treatment of MN, it would
seem prudent to undertake preoperative plantar pressure
measurements to confirm the need for osseous operative
intervention.
Previous studies investigating plantar pressure measurements of patients with generalized forefoot pain have demonstrated increases in peak pressures in the forefoot.21,28
Keijsers et al,25 however, attempted to classify forefoot pain
Table of Contents for the Digital Edition of Foot & Ankle International - July 2018
Contents
Foot & Ankle International - July 2018 - Intro
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Foot & Ankle International - July 2018 - Cover3
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