Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia

Background and Objectives: The anesthetic nerve block test is a surgical technique that can assist in the differential diagnosis of forefoot pain. The MTP joint, enclosed by its capsule, may act as a sealed cavity with predictable contrast dispersion, whereas the IM space, lacking clear boundaries a...

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Autores: Camuñas Nieves, Gabriel, Pérez Sánchez, Hector, Fernández Gibello, Alejandro, Moroni, Simone, Galluccio, Felice, Fajardo Pérez, Mario, Pérez Palma, Laura, Martínez Nova, Alfonso
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:dnet:recercat____::ebfcb13f7e1b2d5a3c68bc37f43e91ef
Acceso en línea:https://hdl.handle.net/2445/228535
Access Level:acceso abierto
Palabra clave:Blocatge nerviós
Nervi vague
Nerve block
Vagus nerve
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spelling Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical MetatarsalgiaCamuñas Nieves, GabrielPérez Sánchez, HectorFernández Gibello, AlejandroMoroni, SimoneGalluccio, FeliceFajardo Pérez, MarioPérez Palma, LauraMartínez Nova, AlfonsoBlocatge nerviósNervi vagueNerve blockVagus nerveBackground and Objectives: The anesthetic nerve block test is a surgical technique that can assist in the differential diagnosis of forefoot pain. The MTP joint, enclosed by its capsule, may act as a sealed cavity with predictable contrast dispersion, whereas the IM space, lacking clear boundaries and containing bursae and the plantar digital nerve, favors diffuse spread. Due to the high rate of false positives in suspected cases of Morton's neuroma with the anesthetic block current procedure in the intermetatarsal space, the aim of this study was to propose an alternative to the current procedure. Material and Methods: Six fresh cadaveric feet were used. Under ultrasound guidance, the 2nd-4th MTP joints received stepwise intra-articular injections of radiopaque contrast. The third common digital nerve was injected within the third intermetatarsal space. Standard radiographs were obtained to assess distribution and proximal spread. Results: A volume of 0.3 mL was sufficient to fully reach the intra-articular cavity and potentially induce effective localized anesthesia. When the third common digital plantar nerve was injected in an anatomically healthy region, the contrast medium showed a proximal diffusion pattern extending up to the mid-diaphyseal level of the third and fourth metatarsal bones. On radiographs, the intra-articular infiltration lines appear sharply demarcated, supporting the interpretation of the metatarsophalangeal joint as a sealed compartment. Conclusions: Low intra-articular anesthetic volumes may yield targeted effects, while Morton's neuroma injections spread proximally, risking loss of diagnostic specificity; this technique may improve decision-making accuracy and reduce failures.MDPI2026202620252026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion10 p.application/pdfhttps://hdl.handle.net/2445/228535Articles publicats en revistes (Ciències Clíniques)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.3390/reports8040211Reports - Clinical Practice and Surgical Cases, 2025, vol. 8, num.4https://doi.org/10.3390/reports8040211cc-by (c) Camuñas-Nieves, G et al., 2025http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:dnet:recercat____::ebfcb13f7e1b2d5a3c68bc37f43e91ef2026-05-29T05:05:01Z
dc.title.none.fl_str_mv Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia
title Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia
spellingShingle Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia
Camuñas Nieves, Gabriel
Blocatge nerviós
Nervi vague
Nerve block
Vagus nerve
title_short Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia
title_full Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia
title_fullStr Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia
title_full_unstemmed Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia
title_sort Anatomical Validation of a Selective Anesthetic Block Test to Differentiate Morton’s Neuroma from Mechanical Metatarsalgia
dc.creator.none.fl_str_mv Camuñas Nieves, Gabriel
Pérez Sánchez, Hector
Fernández Gibello, Alejandro
Moroni, Simone
Galluccio, Felice
Fajardo Pérez, Mario
Pérez Palma, Laura
Martínez Nova, Alfonso
author Camuñas Nieves, Gabriel
author_facet Camuñas Nieves, Gabriel
Pérez Sánchez, Hector
Fernández Gibello, Alejandro
Moroni, Simone
Galluccio, Felice
Fajardo Pérez, Mario
Pérez Palma, Laura
Martínez Nova, Alfonso
author_role author
author2 Pérez Sánchez, Hector
Fernández Gibello, Alejandro
Moroni, Simone
Galluccio, Felice
Fajardo Pérez, Mario
Pérez Palma, Laura
Martínez Nova, Alfonso
author2_role author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Blocatge nerviós
Nervi vague
Nerve block
Vagus nerve
topic Blocatge nerviós
Nervi vague
Nerve block
Vagus nerve
description Background and Objectives: The anesthetic nerve block test is a surgical technique that can assist in the differential diagnosis of forefoot pain. The MTP joint, enclosed by its capsule, may act as a sealed cavity with predictable contrast dispersion, whereas the IM space, lacking clear boundaries and containing bursae and the plantar digital nerve, favors diffuse spread. Due to the high rate of false positives in suspected cases of Morton's neuroma with the anesthetic block current procedure in the intermetatarsal space, the aim of this study was to propose an alternative to the current procedure. Material and Methods: Six fresh cadaveric feet were used. Under ultrasound guidance, the 2nd-4th MTP joints received stepwise intra-articular injections of radiopaque contrast. The third common digital nerve was injected within the third intermetatarsal space. Standard radiographs were obtained to assess distribution and proximal spread. Results: A volume of 0.3 mL was sufficient to fully reach the intra-articular cavity and potentially induce effective localized anesthesia. When the third common digital plantar nerve was injected in an anatomically healthy region, the contrast medium showed a proximal diffusion pattern extending up to the mid-diaphyseal level of the third and fourth metatarsal bones. On radiographs, the intra-articular infiltration lines appear sharply demarcated, supporting the interpretation of the metatarsophalangeal joint as a sealed compartment. Conclusions: Low intra-articular anesthetic volumes may yield targeted effects, while Morton's neuroma injections spread proximally, risking loss of diagnostic specificity; this technique may improve decision-making accuracy and reduce failures.
publishDate 2025
dc.date.none.fl_str_mv 2025
2026
2026
2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/228535
url https://hdl.handle.net/2445/228535
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3390/reports8040211
Reports - Clinical Practice and Surgical Cases, 2025, vol. 8, num.4
https://doi.org/10.3390/reports8040211
dc.rights.none.fl_str_mv cc-by (c) Camuñas-Nieves, G et al., 2025
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Camuñas-Nieves, G et al., 2025
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 10 p.
application/pdf
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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