Foot & Ankle International - July 2018 - 833
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Naraghi et al
Table 4. Contact Time (ms) for 10 Masked Areas and Geometric Measurements for Patients With Morton's Neuroma and Control
Subjects.a
M1CT
M2CT
M3CT
M4CT
M5CT
M6CT
M7CT
M8CT
M9CT
M10CT
FL (cm)
FW (cm)
FPA (deg)
COS
Arch index
MN Right
(n=30)
Control Right
(n = 31)
424 ± 68
490 ± 85
601 ± 74
633 ± 72
634 ± 87
639 ± 74
567 ± 134
517 ± 113
443 ± 119
535 ± 111
25.83 ± 1.54
9.99 ± 0.83
9.85 ± 5.83
0.38 ± 0.02
0.21 ± 0.05
462 ± 71
524 ± 89
625 ± 77
655 ± 73
667 ± 78
658 ± 76
612 ± 75
570 ± 109
443 ± 104
507 ± 116
25.5 ± 1.71
9.94 ± 0.74
10.71 ± 5.89
0.39 ± 0.02
0.22 ± 0.05
P (95% CI)
.04 (2 to 74)
.13 (−10 to 79)
.23 (−15 to 62)
.24 (−15 to 59)
.13 (−9 to 75)
.31 (−19 to 58)
.11 (−10 to 101)
.07 (−3 to 110)
.90 (−57 to 57)
.34 (−86 to 30)
.49 (−1.12 to .55)
.82 (−.45 to .35)
.56 (−2.13 to 3.87)
.47 (−.01 to .16)
.32 (−.01 to .04)
MN Left
(n = 31)
Control Left
(n = 31)
445 ± 96
502 ± 104
632 ± 78
653 ± 76
664 ± 74
656 ± 76
603 ± 78
563 ± 107
426 ± 126
502 ± 134
25.66 ± 1.49
10.12 ± 0.76
8.56 ± 5.74
0.39 ± 0.02
0.20 ± 0.06
451 ± 79
516 ± 94
610 ± 97
649 ± 85
665 ± 86
653 ± 88
605 ± 88
563 ± 121
476 ± 97
505 ± 132
25.46 ± 1.74
10.00 ± 0.76
7.63 ± 6.13
0.39 ± 0.02
0.22 ± 0.05
P (95% CI)
.79 (−39 to 50)
.59 (−37 to 64)
.35 (−66 to 23)
.86 (−45 to 37)
.96 (−40 to 42)
.87 (−45 to 38)
.92 (−40 to 44)
.99 (−58 to 58)
.08 (−7 to 107)
.93 (−65 to 70)
.63 (−1.02 to .62)
.53 (−.51 to .26)
.54 (−3.9 to 2.09)
.67 (−.01 to .01)
.11 (.00 to .05)
Abbreviations: CI, confidence interval; COS, coefficient of spreading; CT, contact time; FL, foot length; FPA, foot progression angle, FW, foot width;
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.
a
Data are expressed as mean ± SD.
on the basis of plantar pressure measurements but did not
find any significant differences in peak pressures under the
metatarsal heads between subjects with (n = 283) and those
without (n = 311) forefoot pain. None of the participants in
their study had a confirmed diagnosis of MN, and 207 subjects had other toe deformities, heel pain, and ankle pain,
which may have affected plantar forefoot pressures. In contrast to our findings, they found that pressure-time integrals
and contact times under metatarsals 2 and 3 were significantly increased in the forefoot pain group in comparison
with their asymptomatic group. They proposed that in subjects without foot deformities, the peak plantar pressure
under the heads of metatarsals was not as important as other
factors such as plantar fat pad thickness and pain tolerance.
Our results showed no significant difference between the
arch index of patients and control subjects, which supports
our previous findings using the Foot Posture Index to compare foot type with the presence of MN.30 Although the Foot
Posture Index is a static measurement of foot type, we did
not see any difference in the arch index measured on the
basis of the dynamic plantar pressure measurement system.
Therefore, on the basis of our subjects, we can conclude
that foot type may not be a sole predisposing factor in the
pathogenesis of MN.
Logically, the presence of pain can potentially alter a
person's gait pattern.41 At the time of the data collection, all
patients were pain free in order for them to meet the inclusion criteria and participate in the EMED testing. In this
manner, we assumed that all subjects with MN did not
guard against pain with an unusual foot strike on the
platform.
There were no significant differences in width, length,
and coefficient of spreading between patients with MN and
control subjects. On the basis of previous studies, men have
wider feet than women.5,38 Male subjects constituted 39%
of the control subjects and approximately 25% of the subjects with MN. No attempt was made to separate men from
women in either group for this part of the data analysis. This
unequal distribution may have affected our results, as there
were higher percentages of men in the control group.
However, a recent study by Park et al34 would seem to support our findings, showing no significant differences
between forefoot width and intermetatarsal distances of
patients with MN compared with a control group using
weightbearing radiographs. Their study did not evaluate
what happens to the width of the forefoot during the pushoff phase. In our study, we did not see any significant differences in forefoot width and coefficient of spreading
dynamically between patients with and those without MN.
This study had some limitations. It was not possible to
confirm the diagnosis of MN by operative histopathology,
and it was necessary to rely on clinical examination and
ultrasound findings to recruit subjects into the study.
However, on the basis of previous literature, clinical
examination17,35 and ultrasound7,42 are highly reliable in
detecting MN. In addition, in future studies it may be beneficial to see a comparison between unaffected and
affected feet for patients with unilateral MN for all EMED
Table of Contents for the Digital Edition of Foot & Ankle International - July 2018
Contents
Foot & Ankle International - July 2018 - Intro
Foot & Ankle International - July 2018 - Cover1
Foot & Ankle International - July 2018 - Cover2
Foot & Ankle International - July 2018 - i
Foot & Ankle International - July 2018 - ii
Foot & Ankle International - July 2018 - Contents
Foot & Ankle International - July 2018 - iv
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Foot & Ankle International - July 2018 - 1B
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Foot & Ankle International - July 2018 - Cover3
Foot & Ankle International - July 2018 - Cover4
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