Morton's neuroma differential diagnosis: Difference between revisions

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==Overview==
==Overview==


[[Morton's neuroma]] must be [[Differentiate|differentiated]] from other [[causes]] of [[pain]] in the [[Foot|forefoot]] such as [[Capsule|capsulitis]], [[intermetatarsal]] [[bursitis]], [[arthritis]] of [[Intermetatarsal articulations|intermetatarsal joints]], [[Callus|calluses]], [[Stress fracture|stress fractures]], and [[Freiberg infraction|Freiberg's disease]].
[[Morton's neuroma]] must be [[Differentiate|differentiated]] from other [[causes]] of [[pain]] in the [[Foot|forefoot]] such as [[metatarsophalangeal joint]]  [[Capsule|capsulitis]], [[intermetatarsal]] [[bursitis]], [[Callus|calluses]], [[Stress fracture|stress fractures]], [[Freiberg infraction|Freiberg's disease]], [[osteomyelitis]], [[Localized disease|localized]] [[vasculitis]], [[ischemia]] of [[plantar]] digital [[artery]], [[tarsal tunnel syndrome]], [[rheumatoid arthritis]], [[peripheral neuritis]], [[synovitis]], [[tendonitis]], and [[avascular necrosis]].
==Differentiating Morton's Neuroma from other Diseases==
==Differentiating Morton's Neuroma from other Diseases==
* Morton's neuroma must be differentiated from other causes of pain in the forefoot because too often all forefoot pain is categorized as neuroma
*[[Morton's neuroma]] must be differentiated from other [[causes]] of [[pain]] in the [[Foot|forefoot]] because too often all [[Foot|forefoot]] [[pain]] is [[Categories|categorized]] as [[neuroma]]
* Since a neuroma is a soft tissue condition, an [[MRI]] should be helpful in diagnosis, however, often an MRI will be inconclusive for neuroma even though a neuroma exists
*Since a [[neuroma]] is a [[soft tissue]] [[condition]], an [[MRI]] should be [[Help Menu|helpful]] in [[diagnosis]], however, often an [[Magnetic resonance imaging|MRI]] will be inconclusive for [[neuroma]] even though a [[neuroma]] exists
* Other conditions to consider are:
*Other [[conditions]] to consider are:<ref>{{cite web |url=http://faoj.org/tag/intermetatarsal-bursitis/ |title=intermetatarsal bursitis &#124; The Foot and Ankle Online Journal |format= |work= |accessdate=}}</ref>
** Capsulitis
**[[Metatarsophalangeal joint]] capsulitis/[[metatarsalgia]]
** Intermetatarsal [[bursitis]] between the third and fourth metatarsal bones will also give neuroma type symptoms because it too puts pressure on the nerve
**[[Intermetatarsal]] [[bursitis]] between the [[Third metatarsal bone|third]] and [[Fourth metatarsal bone|fourth metatarsal bones]] will also give [[neuroma]] type [[symptoms]] because it too puts [[pressure]] on the [[nerve]]
** Arthritis of joints that join the toes to the foot
**[[Callus|Calluses]]
** Calluses
**[[Metatarsal]] [[stress fracture]]
** Stress fractures
**[[Freiberg infraction|Freiberg's disease]]
** Freiberg's disease
**[[Osteomyelitis]]
**[[Localized disease|Localized]] [[vasculitis]]
**[[Ischemia]] or [[Lack (manque)|lack]] of [[blood flow]] through [[plantar]] digital [[artery]], it [[Precedex|precedes]] the [[fibrous]] [[Thickener|thickening]] around the [[nerve]] known as [[Perineural fibroma|perineural]] [[fibrosis]]
**[[Tarsal tunnel syndrome]]
**[[Rheumatoid arthritis]]
**[[Peripheral neuritis]]
**[[Synovitis]]
**[[Tendonitis]]
**[[Avascular necrosis]]
{| class="wikitable"
{| class="wikitable"
|+Differentiating Morton's neuroma from other diseases
|+Differentiating Morton's neuroma from other diseases
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Morton's neuroma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Morton's neuroma
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* [[Improper rotation|Improper]] [[Foot|footwear]] or tight [[Shoe insert|shoes]] with tapered [[toe]] [[box]]
*[[Improper rotation|Improper]] [[Foot|footwear]] or tight [[Shoe insert|shoes]] with tapered [[toe]] [[box]]
* [[Abnormal]] [[Position effect|positioning]] of [[toes]]
*[[Abnormal]] [[Position effect|positioning]] of [[toes]]
* [[Flat feet]]
*[[Flat feet]]
* Overpronation
*Overpronation
* High [[Arches of the foot|foot arches]]
*High [[Arches of the foot|foot arches]]
* High [[Heel|heels]]
*High [[Heel|heels]]
* [[Gait Abnormalities|Gait abnormalities]]
*[[Gait Abnormalities|Gait abnormalities]]
* [[Foot|Forefoot]] [[Problem Solved|problems]] such as:
*[[Foot|Forefoot]] [[Problem Solved|problems]] such as:
** [[Bunion|Bunions]]
**[[Bunion|Bunions]]
** [[Hammer toe|Hammer toes]]
**[[Hammer toe|Hammer toes]]
* High-[[Impacted|impact]] [[Sports medicine|sports]] such as:
*High-[[Impacted|impact]] [[Sports medicine|sports]] such as:
** [[Rock climbing|Rock-climbing]]
**[[Rock climbing|Rock-climbing]]
** Ballet dancing
**Ballet dancing
** Jogging
**Jogging
** [[Running]]
**[[Running]]
** [[Snow]] skiing
**[[Snow]] skiing
** Racquet [[Sports medicine|sports]]
**Racquet [[Sports medicine|sports]]
** Court [[Sports medicine|sports]]
**Court [[Sports medicine|sports]]
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On [[gross pathology]], [[Characteristic impedance|characteristic]] findings of [[morton's neuroma]], include:
On [[gross pathology]], [[Characteristic impedance|characteristic]] findings of [[morton's neuroma]], include:
* Adherent fibrofatty [[Tissue (biology)|tissue]]
*Adherent fibrofatty [[Tissue (biology)|tissue]]
* Small, [[Firming agent|firm]], [[oval]], [[Yellowing|yellowish]]-[[White (mutation)|white]], [[Slow|slowly]] [[Growth|growing]], [[palpable]] [[nodule]] on [[skin]] (no discoloration of [[skin]] on the [[Top note|top]] of [[nodule]])
*Small, [[Firming agent|firm]], [[oval]], [[Yellowing|yellowish]]-[[White (mutation)|white]], [[Slow|slowly]] [[Growth|growing]], [[palpable]] [[nodule]] on [[skin]] (no discoloration of [[skin]] on the [[Top note|top]] of [[nodule]])
* </=2cm in [[Size consistency|size]] [[Size consistency|On]] [[microscopic]] [[histopathological]] [[analysis]], [[Characteristic impedance|characteristic]] findings of [[morton's neuroma]] include:
*</=2cm in [[Size consistency|size]] [[Size consistency|On]] [[microscopic]] [[histopathological]] [[analysis]], [[Characteristic impedance|characteristic]] findings of [[morton's neuroma]] include:
** [[Size consistency|Extensive]] [[fibrosis]] around and within the [[nerve]]
**[[Size consistency|Extensive]] [[fibrosis]] around and within the [[nerve]]
** [[Digit ratio|Digital]] [[artery]]
**[[Digit ratio|Digital]] [[artery]]
** [[Thrombosis]]
**[[Thrombosis]]
** [[Epineurium|Epineural]] and [[Endoneurium|endoneural]] [[arterial]] [[Thickener|thickening]]/[[vascular]] [[Hyaline|hyalinization]]
**[[Epineurium|Epineural]] and [[Endoneurium|endoneural]] [[arterial]] [[Thickener|thickening]]/[[vascular]] [[Hyaline|hyalinization]]
** [[Degenerate|Degenerated]]/[[Demyelination|demyelinated]] [[axons]]
**[[Degenerate|Degenerated]]/[[Demyelination|demyelinated]] [[axons]]
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[[Symptoms]] of [[morton's neuroma]] include:
[[Symptoms]] of [[morton's neuroma]] include:
* [[Feeling]] like <nowiki>''</nowiki>[[walking]] on a marble<nowiki>''</nowiki> or a pebble in the [[Shoe insert|shoe]] or bunched-up sock
*[[Feeling]] like <nowiki>''</nowiki>[[walking]] on a marble<nowiki>''</nowiki> or a pebble in the [[Shoe insert|shoe]] or bunched-up sock
* Most common [[symptom]] is [[pain]] in the [[Affect|affected]] [[area]] [[Causes|caused]] by [[pressure]] on the enlarged [[section]] of [[nerve]] where it [[Passing (sociology)|passes]] between the [[Metatarsal bones|metatarsal]] [[Head (anatomy)|heads]], and is squeezed between them
*Most common [[symptom]] is [[pain]] in the [[Affect|affected]] [[area]] [[Causes|caused]] by [[pressure]] on the enlarged [[section]] of [[nerve]] where it [[Passing (sociology)|passes]] between the [[Metatarsal bones|metatarsal]] [[Head (anatomy)|heads]], and is squeezed between them
* [[Pain]] is persistent & has the following [[Characteristic impedance|characteristics]]:
* [[Pain]] is persistent & has the following [[Characteristic impedance|characteristics]]:
** Occurs mostly on [[weight]] bearing while [[walking]] or [[Wear red day|wearing]] [[Shoe insert|shoes]] that squeeze the [[feet]]
**Occurs mostly on [[weight]] bearing while [[walking]] or [[Wear red day|wearing]] [[Shoe insert|shoes]] that squeeze the [[feet]]
** Occurs [[Frequentism|frequently]] after only a [[Short time duty|short time]]
**Occurs [[Frequentism|frequently]] after only a [[Short time duty|short time]]
** [[Affect|Affects]] the [[contiguous]] [[Half cell|halves]] of two [[toes]]
**[[Affect|Affects]] the [[contiguous]] [[Half cell|halves]] of two [[toes]]
** [[Pain]] tends to ease off at the night [[Time-series|time]]
**[[Pain]] tends to ease off at the night [[Time-series|time]]
** [[Nature]] of [[pain]] maybe any of the following:
**[[Nature]] of [[pain]] maybe any of the following:
*** [[Shooting, shoveling, and shutting up|Shooting]]
***[[Shooting, shoveling, and shutting up|Shooting]]
*** [[Burn|Burning]]
***[[Burn|Burning]]
*** Stabbing
***Stabbing
*** [[Raw]]
***[[Raw]]
*** Gnawing
***Gnawing
*** [[Sick|Sickening]] [[sensations]]
***[[Sick|Sickening]] [[sensations]]
* [[Numbness]]
*[[Numbness]]
* [[Parasthesia]]
*[[Parasthesia]]
* [[Dysesthesia]] ([[painful]] [[hypersensitivity]] to normal [[light]] [[tactile]] [[Stimulants|stimuli]])
*[[Dysesthesia]] ([[painful]] [[hypersensitivity]] to normal [[light]] [[tactile]] [[Stimulants|stimuli]])
* [[Function (biology)|Functional]] [[impairment]]
*[[Function (biology)|Functional]] [[impairment]]
* [[Psychological]] [[distress]] (severely decreasing the [[quality of life]])
*[[Psychological]] [[distress]] (severely decreasing the [[quality of life]])
|Usually [[Location parameter|located]] at the following sites:
|Usually [[Location parameter|located]] at the following sites:
* [[Third metatarsal bone|Third]] [[intermetatarsal]] space most commonly (between [[Third metatarsal bone|third]] and [[Fourth metatarsal bone|fourth metatarsals]])
*[[Third metatarsal bone|Third]] [[intermetatarsal]] space most commonly (between [[Third metatarsal bone|third]] and [[Fourth metatarsal bone|fourth metatarsals]])
* [[Second metatarsal bone|Second]] or [[Fourth metatarsal bone|fourth]] [[Intermetatarsal|interspaces]]
*[[Second metatarsal bone|Second]] or [[Fourth metatarsal bone|fourth]] [[Intermetatarsal|interspaces]]
* At the [[bifurcation]] of the fourth [[plantar]] [[digital nerve]]
*At the [[bifurcation]] of the fourth [[plantar]] [[digital nerve]]
* [[Fifth metatarsal|Fifth]] [[Intermetatarsal|interspace]] ([[Rare|rarely]])
*[[Fifth metatarsal|Fifth]] [[Intermetatarsal|interspace]] ([[Rare|rarely]])
(first [[toe]] is usually not involved)
(first [[toe]] is usually not involved)
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Capsulitis
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Metatarsophalangeal joint]] capsulitis/[[Metatarsalgia]]
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* '''Abnormal''' foot mechanics (putting excessive amount of weight bearing pressure on the ball of the foot beneath the toe joint)
* '''[[Abnormal]]''' [[foot]] [[mechanics]] (putting excessive [[Amount of substance|amount]] of [[weight]] bearing [[pressure]] on the [[Ball (anatomy)|ball]] of the [[foot]] beneath the [[toe]] [[Joint (anatomy)|joint]])
* Repetitive foot motion exerting pressure on the ball of foot resulting in connective tissue degeneration
* [[Repeatability|Repetitive]] [[foot]] [[Motion (physics)|motion]] [[Exertion|exerting]] [[pressure]] on the [[Ball (anatomy)|ball]] of [[foot]] [[Result|resulting]] in [[connective tissue]] [[degeneration]]
* Severe bunion deformity
*High [[Leveling effect|level]] of [[Activity (chemistry)|activity]]
* Second toe longer than the big toe
*Tight [[Achilles tendon]]
* Structurally unstable arch of the foot  
*Severe [[foot]] [[deformities]] such as:
* Tight calf muscles
**[[Bunion]]
**[[Hammer toe]]
*[[Second]] [[toe]] longer than the [[big toe]]
*[[Structural alignment|Structurally]] unstable high [[Arch support|arch]] of [[foot]]
*Prominent [[metatarsal]] [[Head|heads]]
*Tight [[toe]] [[Extensor muscle|extensor muscles]]
*Weak [[toe]] [[Flexor muscle|flexor muscles]]
*[[Hypermobile]] first [[foot]] [[bone]]
*[[Improper rotation|Improper]] fitting [[Shoe insert|footwear]] ([[Womens Pack|women’s]] [[dress]] [[Shoe insert|shoes]], other [[Restriction|restrictive]] [[Shoe insert|footwear]] with narrow [[toe]] [[box]])
*High [[Heel|heels]]
*High [[Impacted|impact]] [[Activities of daily living|activities]]/[[Sports medicine|sports]] without proper footwear/[[orthotics]] such as [[Tracking changes|track]] & field [[running]], tennis, [[Footballs|football]], baseball, & soccer
*Older [[age]] (thinning of [[foot]] [[fat pad]] [[Lead|leads]] to more susceptibility to [[pain]] in the [[Ball (anatomy)|ball]] of the [[foot]])
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* Inflammation of capsule/ligaments that surround two bones, at the level of the joint (in this case, ligaments that attach the toe bone to the metatarsal bone)
*[[Inflammation]] of [[Capsule (anatomy)|capsule]]/[[ligaments]] that surround two [[bones]], at the [[Leveling effect|level]] of the [[Joint (anatomy)|joint]] (in this [[Case-based reasoning|case]], [[ligaments]] that [[Attachment (psychology)|attach]] the [[toe]] [[bone]] to the [[Metatarsal bones|metatarsal bone]])
* Inflammation from this condition will put pressure on an otherwise healthy nerve and give neuroma type symptoms
*[[Inflammation]] from this [[condition]] will put [[pressure]] on an otherwise [[healthy]] [[nerve]] and give [[neuroma]] type [[symptoms]]
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* Pain, particularly on the ball of the foot (feeling of a marble in the shoe or a bunched up sock)
*[[Pain]], particularly on the [[Ball (anatomy)|ball]] of the [[foot]]
* Swelling at the base of the toe
*[[Feeling]] like:
* Difficulty wearing shoes
**A <nowiki>''marble''</nowiki> in the [[Shoe insert|shoe]]
* Pain while walking barefoot
**A bunched up sock
* Crossover toe (end-stage of capsulitis)
**[[Standing (position)|Standing]] on a "pea<nowiki>''</nowiki>
*[[Swelling]] at the [[base]] of the [[toe]]
*Difficulty [[Wear red day|wearing]] [[Shoe insert|shoes]]
*[[Pain]] while [[walking]] [[Barefoot doctor|barefoot]]
*[[Crossover (genetic algorithm)|Crossover]] [[toe]] ([[End-stage disease|end-stage]] of capsulitis)
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*Also [[Reference|referred]] to as <nowiki>''</nowiki>[[Ball (anatomy)|ball]]-of-[[foot]]-[[pain]]<nowiki>''</nowiki>
*Colloquially known as <nowiki>''</nowiki>stone [[bruise]]<nowiki>''</nowiki>
*Usually [[Location parameter|located]] under the 2nd, 3rd, & 4th [[metatarsal]] [[Head|heads]]
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Intermetatarsal [[bursitis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Intermetatarsal]] [[bursitis]]
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*[[Trauma]]
*[[Rheumatoid arthritis]]
*[[Gout]]
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* Between the third and fourth metatarsal bones will give neuroma type symptoms because it too puts pressure on the nerve
*[[Irritation]], [[inflammation]] and [[secondary]] [[fibrosis]] of [[intermetatarsal]] [[bursa]] [[Location parameter|located]] [[distal]] to [[transverse metatarsal ligament]] and [[Close-packing|close]] to [[Neurovascular bundle|neurovascular bundles]]
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*Between the [[Third metatarsal bone|third]] and [[Fourth metatarsal bone|fourth metatarsal bones]] will give [[neuroma]] type [[symptoms]] because it too puts [[pressure]] on the [[nerve]]
*[[Lateral]] [[foot]] [[Compression bandage|compression]] squeezes the [[Inflammation|inflammed]] [[bursa]] between the [[metatarsal]] [[Head|heads]] [[Lead|leading]] to [[pain]] [[Mimics|mimicing]] [[neuroma]]
*[[Mulder's sign]] of [[physical examination]] (squeezing the [[metatarsals]] produces the [[Click chemistry|click]] due to enlarged & [[Inflammation|inflammed]] [[Bursa (anatomy)|bursa]])
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Callus|Calluses]]
|[[Repeatability|Repeated]] contact, [[irritation]], [[friction]] or grinding [[pressure]] to the [[skin]] [[Causes|caused]] by any of the following:
* [[Frequentist|Frequent]] [[walking]]
* Tight or ill-fitting [[Shoe insert|shoes]] ([[feet]] [[Callus (cell biology)|callus]])
* Dancing [[Barefoot doctor|barefoot]] especially ballet ([[Callus (cell biology)|callus]] at the [[Sole of the foot|sole of foot)]]
* [[Play therapy|Playing]] [[Musical pitch|musical]] or string instruments such as guitar, violin, pizzicato, strumming (fourth [[finger]] [[Callus (cell biology)|callus]])
* [[Weight]] [[Lift|lifting]] (upper [[Palmar|palm]] [[area]] [[Callus (cell biology)|callus]])
* [[Rock climbing]] ([[Callus (cell biology)|callus]] of all of the [[fingers]])
* [[Construction site safety|Construction]] [[Work accident|work]]
* [[Wood]] [[Carving wax|carving]]
* [[Play therapy|Playing]] [[video]] [[Game of chance|games]] [[Usage analysis|using]] a [[Control|controller]] with a poor D-pad ([[thumb]] [[Callus (cell biology)|callus]])
* [[Frequentist|Frequent]] [[Usage analysis|use]] of a [[writing]] [[Implementation Plan|implement]] ("[[Writer invariant|writer's]] [[Bumps on skin|bump]]"-[[Callus (cell biology)|callus]] of the [[middle finger]])
* [[Usage analysis|Use]] of chef's knife
* Hiking
* [[Martial arts]]
* [[Weight training]]
* [[Rowing exercise|Rowing]]
* BMXing
* Chopping [[wood]]
* [[Monkey]] [[bars]]
* Tenpin bowlers ([[thumb]] and [[middle finger]] [[Callus (cell biology)|calluses]])
* [[Forehead]] [[Callus (cell biology)|callus]] called prayer [[Bumps on skin|bump]] or ''zebiba'' formed by muslim prayer
* [[Diabetes]]
* [[Arsenic]]
* [[Syphilis]]
* [[Actinic keratosis]]
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* [[Callus (cell biology)|Callus]] is a toughened [[area]] of the [[skin]] which has become [[Relatively compact|relatively]] [[Thickener|thick]] and hard as a [[Response element|response]] to [[Repeatability|repeated]] or [[constant]] contact, grinding [[pressure]], [[irritation]] or [[friction]]
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* Usually involves [[hands]] or [[feet]]
* [[Infection]] of [[Callus (cell biology)|callus]]
* [[Bleeding]] of [[Callus (cell biology)|callus]] in [[diabetics]] especially
* [[Skin ulceration]]
* [[Blisters]] (due to [[Frequentist|frequent]] rubbing)
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* '''[[Corns]]''' ('''clavi''') are specially-[[Shape parameter|shaped]] [[Callus (cell biology)|calluses]] of [[Dead body|dead]] [[skin]] that usually occur on:
** Thin or [[Glabrousness|glabrous]] ([[hairless]] and [[Smooth pursuit|smooth]]) [[skin]] [[Surface anatomy|surfaces]] (especially on the [[Dorsal|dorsa]] of [[toes]] or [[fingers]])
**[[Thickener|Thick]] [[palmar]] [[skin]] [[Surface anatomy|surface]]
**[[Thickener|Thick]] [[plantar]] [[skin]] [[Surface anatomy|surface]]
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Arthritis of metatarsophalangeal joints (join the toes to the foot)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Metatarsal]] [[stress fracture]]<ref name="pmid17805074">{{cite journal| author=Kelsey JL, Bachrach LK, Procter-Gray E, Nieves J, Greendale GA, Sowers M et al.| title=Risk factors for stress fracture among young female cross-country runners. | journal=Med Sci Sports Exerc | year= 2007 | volume= 39 | issue= 9 | pages= 1457-63 | pmid=17805074 | doi=10.1249/mss.0b013e318074e54b | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17805074  }} </ref>
|[[Repeatability|Repeated]] extraordinary [[Stress (medicine)|stress]], overuse, or [[trauma]] to the [[bone]] [[Causes|caused]] by any of the following:
* Sudden undertake of a [[Bursting|burst]] of [[exercise]] in a [[Sedentary behavior|sedentary]] [[person]]
* Olympic-class [[Athletic training|athletics]] (extraordinary [[Quantitative|quantities]] of high-[[Impact factor|impact]] [[exercise]])
* Long [[Distance matrix|distance]] marches ([[Military medicine|military]] [[Recruitment status|recruits]])
*[[Running]] ([[Tracking changes|track]] and [[Field desorption|field]] [[athletes]])
*[[Jumping]]
*[[Sports Medicine|Sports]] such as soccer, tennis, gymnastics & basketball
*[[Muscle]] [[fatigue]]
* Previous [[stress fracture]]
*[[Osteoporosis]] (weakens the [[bone]], [[Causes|causing]] [[stress fracture]] by just normal [[Activity (chemistry)|activity]])
*[[Flat feet]]
* High or rigid [[foot]] [[Archae|arch]]
*[[Lack (manque)|Lack]] of [[nutrients]] due to [[eating disorders]], [[Lack (manque)|lack]] of [[vitamin D]] & [[calcium]]
*[[Menopause]] (or [[Womens Pack|women]] with [[abnormal]] [[menstrual cycles]])
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* Over the [[Time constant|time]], if enough [[Stress (medicine)|stress]] is [[Place cell|placed]] on the [[bone]] [[Repeatability|repetitively]], it [[Exhaustion|exhausts]] the capacity of the [[bone]] to remodel without enough [[Time constant|time]] for [[recovery]] resorb [[Cells (biology)|cells]] faster than [[Human body|body]] can [[Replacement joint|replace]] them, [[Result|resulting]] in a weakened site [[Causes|causing]] tiny [[Cracking (chemistry)|cracks]] in a [[bone]], or severe [[bruising]] within a [[bone]] [[Lead|leading]] to [[stress fracture]]
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*[[Local]] [[pain]] (worsens with [[Time constant|time]])
*[[Local]] [[Tenderness (medicine)|tenderness]] (originates from a [[Specific activity|specific]] [[spot]] & decreases during [[Rest cure|rest]])
*[[Swelling]] around the [[painful]] [[area]]
|[[Stress fracture]] can be [[Prevention (medical)|prevented]] by following [[Measurement|measures]]:
* Starting [[new]] [[exercise]] gradually with [[slow]] progression
*[[Usage analysis|Using]] proper [[Foot|footwear]]
* Adding low-[[Impact factor|impact]] [[Activities of daily living|activities]] to the [[exercise]] regimen to avoid putting [[Stress (medicine)|stress]] on a particular [[Human body|body]] part
*[[Strength training|Strengthening]] [[exercises]] for [[Calf muscle|calf]] and [[shin]] [[muscles]] to [[Avoidance response|avoid]] [[muscle fatigue]]
*[[Get involved|Getting]] [[Appropriate Use Criteria|appropriate]] [[nutrition]] (especially in [[osteoporosis]] & [[menopause]]) having [[Adequately wet|adequate]] [[Amount of substance|amounts]] of:
**[[Vitamin D]]
**[[Calcium]]
**[[Essential nutrients]]
<br />
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Freiberg infraction|Freiberg's disease]]
|[[Etiology]] is usually unknown or maybe [[Multifactorial inheritance|multifactorial]] such as:
* [[Trauma|Traumatic]] insult (either [[Acute (medicine)|acute]] or [[Repeatability|repetitive]] [[injury]])
* [[Vascular insufficiency|Vascular compromise]]
* High-[[Heel|heeled]] [[Shoe insert|shoes]]
<br />
|[[Vascular insufficiency|Vascular compromise]] [[Lead|leads]] to:
* [[Collapse (medical)|Collapse]] of the subchondral [[bone]]
* [[Osteonecrosis]]
* [[Cartilaginous]] [[fissures]]
|Usually invovles the [[Second metatarsal bone|second]] or [[Third metatarsal bone|third metatarsal heads]] [[Causes|causing]]:
* [[Pain]]
* Limited [[Motion (physics)|motion]]
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* More common in [[Womens Pack|women]]
* Manifests during [[adolescence]] (most commonly)
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Osteomyelitis]]
|Common [[causes]] include:
*[[Staphylococcus aureus]]
*[[Streptococcus pyogenes]]
*[[Haemophilus influenzae]]
*[[Enterobacter]]
*[[Escherichia coli]]
*[[Pseudomonas]]
*[[Streptococcus pneumoniae]]
*[[Mycobacterium tuberculosis]]
*[[Cellulitis]]
*[[Septic arthritis]]
*[[Fracture]]
<br />
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Entry of the [[organism]] into [[bone]] is the first [[Step function|step]] in [[osteomyelitis]] and occurs by three [[Main Page|main]] [[Mechanisms of action|mechanisms]]:
# [[Blood|Hematogenous]] [[Seed contamination|seeding]]
# [[Contiguous]] [[Spreading activation|spread]] of [[infection]] to [[bone]] from adjacent [[soft tissue]]
# [[Direct Fick|Direct]] [[inoculation]] from [[trauma]] or [[orthopedic surgery]] (including [[prostheses]])
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*[[Systemic]] [[symptoms]] include:
**[[Chills]]
**[[Headache]]
**[[Fatigue]]
**[[Anorexia]]
**[[Fever]]
**[[Malaise]]
*[[Local]] [[symptoms]] include:
**[[Pain]]
**[[Edema]]
**[[Erythema]]
**Warmth
|[[Risk factors]] for [[osteomyelitis]] include:
*[[Diabetes]]
*[[Hemodialysis]]
* [[Immunocompromised]] [[patients]]
* [[Tuberculosis]] [[infection]]
* [[IV drug use]]
* Poor [[blood circulation]]
* [[Sickle-cell disease]]
* [[Recent changes|Recent]] [[trauma]]
* [[Orthopedic surgery]]
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Calluses
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Localized disease|Localized]] [[vasculitis]]<ref name="pmid11296994">{{cite journal| author=Burke AP, Virmani R| title=Localized vasculitis. | journal=Semin Diagn Pathol | year= 2001 | volume= 18 | issue= 1 | pages= 59-66 | pmid=11296994 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11296994  }} </ref><ref name="pmid12628039">{{cite journal| author=Quinet RJ, Zakem JM, McCain M| title=Localized versus systemic vasculitis: diagnosis and management. | journal=Curr Rheumatol Rep | year= 2003 | volume= 5 | issue= 2 | pages= 93-9 | pmid=12628039 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12628039  }} </ref>
|
|
*'''[[Infectious]] and [[Immune mediated inflammatory diseases|immune mediated diseases]]''' ([[anti-cardiolipin antibodies]], [[arthus reaction]], [[bazin disease]], [[behcet's disease]], [[buerger's disease]], [[Acquired C1-esterase inhibitor deficiency|C1 esterase inhibitor (C1-INH) deficiency]], [[cholesterol embolism]],[[cryoglobulinemia]], [[cutis marmorata telangiectatica congenita]], [[degos disease]], [[Tetanus and Diphtheria Vaccine|diptheria & tetanus vaccine]],[[familial Mediterranean fever]], [[golfer's vasculitis]], [[hepatitis C]], [[Hughes-Stovin syndrome]], [[hypersensitivity vasculitis]], [[juvenile dermatomyositis]], [[late congenital syphilitic oculopathy]], [[lepromatous leprosy]], [[livedoid vasculitis]],[[necrobiosis lipoidica]], [[neisseria meningiditis]], [[pancreatitis]], [[parvovirus B19 infection]], [[polychondritis]], [[polymyalgia rheumatica]], [[polymyositis]], [[rapidly progressive glomerulonephritis]], [[rheumatoid arthritis]],  [[sneddon syndrome]], [[streptococcus Group A]],[[sweet's syndrome]], [[systemic lupus erythematosus]], [[thromboangiitis obliterans]], [[treponema pallidum]],[[tuberculosis]])
*'''[[Smoking]]'''
*'''[[Cancers]]''' such as:
**[[Lung cancer]]
**[[Pancreatic cancer]]
*'''[[Drugs]]''' ([[Allopurinol]], [[amantadine]], [[benzylthiouracil]], [[cefaclor]], [[cocaine]],[[cytarabine]], [[hydralazine]], [[indinavir]],[[isoniazid]], [[isotretinoin]], [[janumet]] ([[sitagliptin]] and [[metformin]]), [[methotrexate]][[metolazone]], [[minocycline]], [[oxaprozin]], [[penicillamine]], [[pergolide]], [[phenytoin]], [[propylthiouracil]], [[quinidine]], [[trazodone]], [[trovafloxacin mesylate]]) <br />
|
|
*[[Local|Localized]] [[inflammation]] of [[blood vessels]] occurs within a confined [[vascular]] [[Distribution (pharmacology)|distribution]] or a single [[Organ (anatomy)|organ]] is involved without any [[clinical]] [[evidence]] of [[Generalization|generalized]] [[inflammation]]
*[[Inflammation]] can be [[Causes|caused]] by [[infection]] or [[cancer]] or [[Immune mediated inflammatory diseases|immune mediated]] by [[antibodies]] or certain [[drugs]]
|
|
*[[Patient]] [[Feeling|feels]] '''[[sick]]'''
*[[Fever]]
*[[Weight loss]]
*[[Fatigue]]
*[[Rapid pulse]]
*[[Diffuse]] [[aches]]
*[[Diffuse pain|Diffuse pains]] (difficult to pinpoint)
*[[Claudication]]
*[[Bruit]]
*[[Hypertension]]
*Focal [[Neurological disorder|neurological deficit]]
*[[Rest cure|Rest]] of the [[symptoms]] [[Dependent variable|depend]] on the [[Organ (anatomy)|organ]] involved such as:
**'''[[Nerves]]''' (shooting [[pain]] in [[Arm|arms]] & [[legs]], [[numbness]], asymmetrical [[Weakness (medical)|weakness]])
**'''[[Skin]]''' ([[palpable]] [[purpura]], [[Hyperpigmentation|hyperpigmented]] [[Area|areas]])
**'''[[Joints (anatomy)|Joints]]''' (full–blown [[arthritis]], [[arthralgia]], [[joint swelling]])
**'''[[Lungs]]''' ([[cough]], [[shortness of breath]], [[hemoptysis]], [[cavities]] & infiltrates in [[lungs]], [[pneumonia]]-like [[appearance]] on [[Chest X-ray|CXR]])
**'''[[Kidneys]]''' ([[RBCs]] & [[protein]] in [[urine]], [[renal insufficiency]])
**'''[[Gastrointestinal tract|GIT]]''' ([[abdominal pain]], [[bloody diarrhea]], [[Gastrointestinal perforation|intestinal perforation]])
**'''[[Blood]]''' ([[anemia]], increased [[White blood cells|WBCs]] count)
**'''[[Sinus & Nose|Sinus, nose]] & [[ears]]''' ([[hearing loss]], [[Chronic (medical)|chronic]] [[sinus]] [[congestion]] & [[infection]], [[inflammation]] of the [[nasal septum]] may [[result]] in the [[Collapse (medical)|collapse]]/[[perforation]] of the [[Bridge (dentistry)|bridge]] of [[nose]])
**'''[[Eyes]]''' (sudden [[loss of vision]], [[conjunctivitis]]-[[pink eye]])
**'''[[CNS]]''' ([[headache]], [[stroke]], [[altered mental status]], difficulty with [[coordination]])
|
|
*Birmingham [[Vasculitis]] [[Activity (chemistry)|Activity]] [[Score test|Score]] is a very [[Value (mathematics)|valuable]] tool to find out any [[systemic]] involvement going on [[Concurrent overlap|concurrently]] with [[Local|localized]] [[vasculitis]]
*Can involve any [[Organ (anatomy)|organ]]
*It is often [[Reference|referred]] to as a <nowiki>''</nowiki>Hurting [[disease]]<nowiki>''</nowiki>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Stress fractures
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Tarsal tunnel syndrome]] (TTS)
|Anything that creates [[pressure]] in the [[Tarsal]] Tunnel can [[Causes|cause]] TTS such as:
*[[Benign tumors]]
*[[Cysts]]
*[[Bone spurs]]
*[[Inflammation]] of the [[tendon sheath]]
*[[Nerve]] [[Ganglion|ganglions]]
*[[Swelling]] from a broken or [[sprained ankle]]
*[[Varicose veins]]
*[[Flat feet]]
*[[Back]] [[Problem Solved|problems]] with the L4, L5 and S1 regions ("Double [[Crush injury|Crush]]" issue)
|
*[[Painful]] [[foot]] [[condition]] [[Causes|caused]] by [[Compressibility|compression]] and [[Impingement Syndrome|impingement]] of [[tibial nerve]] as it [[Travel medicine|travels]] through the [[tarsal tunnel]]
|
|
*[[Pain]] in and around [[Ankle|ankles]], [[toes]], with following [[Features (pattern recognition)|features]]:
**[[Radiation (medicine)|Radiation]] to [[Leg (anatomy)|leg]], [[Arch support|arch]], or [[heel]]
**Occurs while [[Operation (mathematics)|operating]] automobiles
**Occurs  along the [[Posterior]] [[Tibial nerve]] [[Path analysis|path]]
**Worsens and [[Spreading activation|spreads]] after [[Activity (chemistry)|activity]] and [[Standing (position)|standing]] for long periods
**Relieved by [[Rest cure|rest]]
*[[Swelling]] of the [[feet]]
*[[Burn|Burning]] [[sensation]] on the [[Bottom feeder|bottom]] of [[foot]] [[Radiation|radiating]] upward
*[[Tingling]] ([[Parasthesia|parasthesias]])
*[[Numbness|Numb sensations]]
*[[Electric shock]] [[sensations]]
*Hot and [[cold]] [[sensations]] in the [[feet]]
*[[Feeling]] of [[feet]] having not enough padding
*[[Burn|Burning]]
*Increased [[sensations]] in the [[feet]]
*Positive [[Tinel's sign]]
|
|
*Also known as [[Posterior]] [[Tibial]] [[Nerve]] [[Neuralgia]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Rheumatoid arthritis]]<ref name="pmid19790122">{{cite journal |vauthors=Barton A, Worthington J |title=Genetic susceptibility to rheumatoid arthritis: an emerging picture |journal=Arthritis Rheum. |volume=61 |issue=10 |pages=1441–6 |date=October 2009 |pmid=19790122 |doi=10.1002/art.24672 |url=}}</ref><ref name="pmid20436074">{{cite journal |vauthors=Hitchon CA, Chandad F, Ferucci ED, Willemze A, Ioan-Facsinay A, van der Woude D, Markland J, Robinson D, Elias B, Newkirk M, Toes RM, Huizinga TW, El-Gabalawy HS |title=Antibodies to porphyromonas gingivalis are associated with anticitrullinated protein antibodies in patients with rheumatoid arthritis and their relatives |journal=J. Rheumatol. |volume=37 |issue=6 |pages=1105–12 |date=June 2010 |pmid=20436074 |doi=10.3899/jrheum.091323 |url=}}</ref><ref name="pmid21343168">{{cite journal |vauthors=Routsias JG, Goules JD, Goules A, Charalampakis G, Pikazis D |title=Autopathogenic correlation of periodontitis and rheumatoid arthritis |journal=Rheumatology (Oxford) |volume=50 |issue=7 |pages=1189–93 |date=July 2011 |pmid=21343168 |doi=10.1093/rheumatology/ker090 |url=}}</ref><ref name="pmid10366115">{{cite journal |vauthors=Barrett JH, Brennan P, Fiddler M, Silman AJ |title=Does rheumatoid arthritis remit during pregnancy and relapse postpartum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy |journal=Arthritis Rheum. |volume=42 |issue=6 |pages=1219–27 |date=June 1999 |pmid=10366115 |doi=10.1002/1529-0131(199906)42:6<1219::AID-ANR19>3.0.CO;2-G |url=}}</ref><ref name="pmid26435495">{{cite journal |vauthors=Louati K, Berenbaum F |title=Fatigue in chronic inflammation - a link to pain pathways |journal=Arthritis Res. Ther. |volume=17 |issue= |pages=254 |date=October 2015 |pmid=26435495 |pmc=4593220 |doi=10.1186/s13075-015-0784-1 |url=}}</ref><ref name="pmid23335492">{{cite journal |vauthors=Nikolaus S, Bode C, Taal E, van de Laar MA |title=Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review |journal=Arthritis Care Res (Hoboken) |volume=65 |issue=7 |pages=1128–46 |date=July 2013 |pmid=23335492 |doi=10.1002/acr.21949 |url=}}</ref>
|Common [[causes]] include:
*[[Idiopathic]]
*[[Genetic]] ([[HLA-DR4]] [[Cluster (epidemiology)|cluster]], [[HLA-DR1]])
*[[Environmental science|Environmental]] ([[smoking]])
*[[Hormonal]] [[Hyperprolactinemia|(hyperprolactinemia]])
*[[Immunological|Immunologic]]
*[[Infections]] ([[mycoplasma]], [[Epstein Barr virus|epstein-Barr virus]], [[rubella virus]], [[porphyromonas gingivalis]])
*Socioeconomic factors
*[[Psychological]] factors
*[[Lifestyle]] factors ([[obesity]], poor [[health]])
|
|
On [[gross pathology]], following [[Features (pattern recognition)|features]] may be noticed:
* [[Irregular lesion|Irregular]] [[Surface anatomy|surface]], seen due to [[synovial]] [[hyperplasia]]
* Subchondral [[cysts]](usually [[Presenting symptom|present]] at the later stage of [[disease]]
[[Microscopic]] [[histopathological]] [[analysis]] shows:
* [[Formation matrix|Formation]] of [[new]] [[synovial]] [[Blood vessel|blood vessels]] (earliest finding)
* [[Hypertrophy (medical)|Hypertrophy]] of [[synovial]] [[Line|lining]] layer
* [[Infiltration (medical)|Infiltration]] of [[mononuclear cells]]
* [[Chronic (medical)|Chronic]] [[inflammation]] with [[lymphocytic]] [[Infiltration (medical)|infiltration]]
* [[Pannus]] [[Formation matrix|formation]] (fibrovascular [[Tissue (biology)|tissue]] or [[granulation tissue]])
|
|
Common [[symptoms]] of [[rheumatoid arthritis]] include:
* [[Joint pain]] involving small [[Joints (anatomy)|joints]] of the [[hands]], [[wrist]], and [[foot]]
* [[Joint swelling]]
* [[Morning report (medicine)|Morning]] [[joint stiffness]] classically lasting for more than an hour
* Decreased [[Grippe|grip]] [[Strength training|strength]]
* [[Generalization|Generalized]] [[aching]]
* [[Fatigue]]
* [[Weight loss]]
* [[Depression]]
* Less commonly, involvement of [[cervical spine]] leads to [[neurological]] [[symptoms]] such as:
** [[Tingling]] in the [[arm]]
** [[Numbness]] in the [[arm]]
** [[Weakness]] in the [[arm]]
|[[Condition|Conditions]] [[Association (statistics)|associated]] with [[rheumatoid arthritis]] include:
* [[Osteopenia]]
* [[Myositis]]
* [[Vasculitis]]
* [[Uveitis]]
* [[Scleritis]]
* [[Periphery|Peripheral]] [[ulcerative keratitis]]
* [[Interstitial fibrosis]]
* [[Pulmonary]] [[nodules]]
* [[Bronchiolitis obliterans]]
* [[Organizing pneumonia]]
* [[Venous thromboembolism]]
* [[Pericarditis]]
* [[Myocarditis]]
* [[Congestive heart failure]]
* [[Atrial fibrillation]]
* [[Sjogren's syndrome]]
* [[Felty's syndrome]]
[[Patients]] with [[rheumatoid arthritis]] may have a positive [[History and Physical examination|history]] of:
* [[Smoking]]
* [[Family history]]
* [[Autoimmune disease]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Freiberg's disease
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Peripheral neuritis]]
|
|
*[[Infection]]:
**[[Herpes simplex]]
**[[Shingles]]
**[[Leprosy]]
**[[Guillain-Barré syndrome|Guillain-Barre syndrome]]
*[[Chemical]] [[injury]]
*[[Physical injury]]
*[[Radiation]]
*[[Drugs]]: [[Disulfiram]], [[Pergolide]], [[Vinblastine]]
*[[Underlying representation|Underlying]] [[conditions]] [[Causes|causing]] [[Local|localized]] [[neuritis]] ([[Affect|affecting]] a single [[nerve]]):
**[[Diphtheria]]
**[[Local|Localized]] [[injury]]
**[[Diabetes]]
*Underlying [[conditions]] [[Causes|causing]] [[polyneuritis]] ([[Affect|affecting]] multiple [[nerves]]):
**[[Beriberi]]
**[[Vitamin B12 deficiency]]
**[[Metabolic diseases]]
**[[Diabetes]]
**[[Hypothyroidism]]
**[[Porphyria]]
**[[Infections]], [[bacterial]] and/or [[viral]]
**[[Autoimmune disease]], especially [[Multiple sclerosis|Multiple Sclerosis]]
**[[Cancer]]
**[[Alcoholism]]
**[[Wartenbergs migratory sensory neuropathy]]
|
|
*General [[inflammation]] of the [[peripheral nervous system]]
|[[Symptoms]] [[Dependent variable|depend]] on the [[nerve]] involved and may include:
*[[Pain]]
*[[Paresthesia]] [[paresis]]
*[[Hypoesthesia]] ([[numbness]])
*[[Anesthesia]]
*[[Paralysis]]
*[[Wasting]]
*Disappearance of the [[reflexes]]
|_
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Synovitis]]
|It can be [[Causes|caused]] by any of the following:
*[[Chondrocalcinosis]]
*[[Haemophilia type A]]
*[[Lupus]]
*[[Pigmented villonodular synovitis]]
*[[Polymyalgia rheumatica|Polymyalgia Rheumatica]]
*[[Rheumatoid arthritis]]
*[[Osteoarthritis]]
*[[SAPHO syndrome]]
*[[Systemic sclerosis]]
*Jacobs [[arthropathy]]-[[camptodactyly]] [[syndrome]] (an [[autosomal recessive disorder]])
*[[Gout]]
|
*[[Inflammation]] of a [[synovial membrane]] ([[line]] those [[Joints (anatomy)|joints]] which possess [[cavities]], namely [[synovial joints]])
*Long term presence of [[synovitis]] can result in [[Degeneration (medical)|degeneration]] of the [[Joint (anatomy)|joint]]
|
*[[Joint pain]] or [[Tenderness (medicine)|tenderness]]
*[[Joint swelling]] (it is a better [[indicator]] of [[synovitis]] rather than [[Tenderness (medicine)|tenderness]] in [[rheumatoid arthritis]])
*Hard [[Lump|lumps]] ([[nodules]])
|_
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Tendonitis]]
|
*[[Chronic (medical)|Chronic]] overuse of [[tendons]]
*[[Drug]] [[side effect]]:
**[[Ciprofloxacin]]
**[[Gemifloxacin mesylate]]
**[[Levofloxacin]]
**[[Norfloxacin]]
|
*[[Inflammation]] of a [[tendon]]
*[[Microscopic]] [[tears]] within the disorganized [[collagen]] [[matrix]]
|
*[[Ache]] or [[pain]] [[Local|locally]] (increased during and after [[Activity (chemistry)|activity]])
*Local [[stiffness]] (in the [[area]] of involved [[tendon]])
*[[Burn|Burning]] of the whole [[joint]] surrounding the [[Inflammation|inflammed]] [[tendon]]
*Local [[swelling]]
|
*Common in the [[Upper limbs|upper]] and [[lower limbs]] (including the [[rotator cuff]] [[Attachment (psychology)|attachments]])
*Less common in the [[hips]] and [[torso]]
*[[Tendinitis]] of different [[Human body|body parts]] alongwith [[Specific activity|specifically]] involved [[Etiology|etiological]] [[Activity (chemistry)|activity]] is given below:
**[[Tendinitis]] of [[fingers]] in [[Rock climbing|rock climbers]]
**[[Shoulder]] [[tendinitis]] in [[Swimming|swimmers]]
**[[Achilles tendinitis]] due to [[Sports medicine|sports]] such as lunging & [[jumping]]
** [[Patellar tendinitis]] in basketball & volleyball players
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Avascular necrosis]]<ref name="pmid31210694">{{cite journal| author=Enge Junior DJ, Fonseca EKUN, Castro ADAE, Baptista E, Santos DDCB, Rosemberg LA| title=Avascular necrosis: radiological findings and main sites of involvement - pictorial essay. | journal=Radiol Bras | year= 2019 | volume= 52 | issue= 3 | pages= 187-192 | pmid=31210694 | doi=10.1590/0100-3984.2017.0151 | pmc=6561372 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31210694  }} </ref>
|Permanent or temporary [[Lack (manque)|lack]] of [[blood]] supply to the [[bones]] due to:
*[[Trauma]]
*Non-[[Trauma|traumatic]] [[etiologies]] include:
**[[Alcoholism]]
**[[Excess risk|Excessive]] [[Glucocorticoid|steroid]] [[Usage analysis|use]]
**[[Caisson disease]] ([[decompression sickness]])
**[[Vascular]] [[Compression fracture|compression]]
**[[Hypertension]]
**[[Vasculitis]]
**[[Thrombosis]]
**Damage from [[radiation]]
**[[Bisphosphonates]] (particularly the [[mandible]])
**[[Sickle cell anaemia]] (very [[Rare|rarely]])
**[[Idiopathic]] (no [[Causes|cause]] is found in some [[Case-based reasoning|cases]])
<br />
|
|
*[[Lack (manque)|Lack]] of [[blood]] supply [[Lead|leads]] to [[Death cap|death]] of [[bone tissue]] [[Causes|causing]] [[bone]] to [[Collapse (medical)|collapse]]
|
|
*Initially, it remains painless
*[[Pain]] in the [[Affect|affected]] [[Joint (anatomy)|joint]] is the first [[symptom]] especially with [[Usage analysis|use]] or [[weight]]<nowiki/>bearing
*[[Limp]] during [[walking]] (if [[lower extremity]] is involved)
|Also known as:
*[[Osteonecrosis]]
*[[Aseptic bone necrosis]]
*[[Ischemic]] [[bone]] [[necrosis]]
Common sites of involvement in the [[Order (biology)|order]] of [[frequency]] include:
*[[Shoulder]]
*[[Knee]]
*[[Hip (anatomy)|Hip]]
*[[Epiphysis]] of [[long bones]] such as [[femur]]
*[[Humerus]] (the [[bone]] of the [[upper arm]])
*[[Knees]]
*[[Shoulders]]
*[[Ankle|Ankles]]
*[[Osteonecrosis of the jaw|Jaw]]
|}
|}



Latest revision as of 14:34, 26 June 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

Overview

Morton's neuroma must be differentiated from other causes of pain in the forefoot such as metatarsophalangeal joint capsulitis, intermetatarsal bursitis, calluses, stress fractures, Freiberg's disease, osteomyelitis, localized vasculitis, ischemia of plantar digital artery, tarsal tunnel syndrome, rheumatoid arthritis, peripheral neuritis, synovitis, tendonitis, and avascular necrosis.

Differentiating Morton's Neuroma from other Diseases

Differentiating Morton's neuroma from other diseases
Disease/Condition Underlying Etiology Pathophysiology Clinical presentation Other associated features
Morton's neuroma

On gross pathology, characteristic findings of morton's neuroma, include:

Symptoms of morton's neuroma include:

Usually located at the following sites:

(first toe is usually not involved)

Metatarsophalangeal joint capsulitis/Metatarsalgia
Intermetatarsal bursitis _
Calluses Repeated contact, irritation, friction or grinding pressure to the skin caused by any of the following:
Metatarsal stress fracture[2] Repeated extraordinary stress, overuse, or trauma to the bone caused by any of the following: Stress fracture can be prevented by following measures:


Freiberg's disease Etiology is usually unknown or maybe multifactorial such as:


Vascular compromise leads to: Usually invovles the second or third metatarsal heads causing:
Osteomyelitis Common causes include:


Entry of the organism into bone is the first step in osteomyelitis and occurs by three main mechanisms:

  1. Hematogenous seeding
  2. Contiguous spread of infection to bone from adjacent soft tissue
  3. Direct inoculation from trauma or orthopedic surgery (including prostheses)
Risk factors for osteomyelitis include:
Localized vasculitis[3][4]
Tarsal tunnel syndrome (TTS) Anything that creates pressure in the Tarsal Tunnel can cause TTS such as:
Rheumatoid arthritis[5][6][7][8][9][10] Common causes include:

On gross pathology, following features may be noticed:

Microscopic histopathological analysis shows:

Common symptoms of rheumatoid arthritis include:

Conditions associated with rheumatoid arthritis include:

Patients with rheumatoid arthritis may have a positive history of:

Peripheral neuritis Symptoms depend on the nerve involved and may include: _
Synovitis It can be caused by any of the following: _
Tendonitis
Avascular necrosis[11] Permanent or temporary lack of blood supply to the bones due to:


Also known as:

Common sites of involvement in the order of frequency include:

References

  1. "intermetatarsal bursitis | The Foot and Ankle Online Journal".
  2. Kelsey JL, Bachrach LK, Procter-Gray E, Nieves J, Greendale GA, Sowers M; et al. (2007). "Risk factors for stress fracture among young female cross-country runners". Med Sci Sports Exerc. 39 (9): 1457–63. doi:10.1249/mss.0b013e318074e54b. PMID 17805074.
  3. Burke AP, Virmani R (2001). "Localized vasculitis". Semin Diagn Pathol. 18 (1): 59–66. PMID 11296994.
  4. Quinet RJ, Zakem JM, McCain M (2003). "Localized versus systemic vasculitis: diagnosis and management". Curr Rheumatol Rep. 5 (2): 93–9. PMID 12628039.
  5. Barton A, Worthington J (October 2009). "Genetic susceptibility to rheumatoid arthritis: an emerging picture". Arthritis Rheum. 61 (10): 1441–6. doi:10.1002/art.24672. PMID 19790122.
  6. Hitchon CA, Chandad F, Ferucci ED, Willemze A, Ioan-Facsinay A, van der Woude D, Markland J, Robinson D, Elias B, Newkirk M, Toes RM, Huizinga TW, El-Gabalawy HS (June 2010). "Antibodies to porphyromonas gingivalis are associated with anticitrullinated protein antibodies in patients with rheumatoid arthritis and their relatives". J. Rheumatol. 37 (6): 1105–12. doi:10.3899/jrheum.091323. PMID 20436074.
  7. Routsias JG, Goules JD, Goules A, Charalampakis G, Pikazis D (July 2011). "Autopathogenic correlation of periodontitis and rheumatoid arthritis". Rheumatology (Oxford). 50 (7): 1189–93. doi:10.1093/rheumatology/ker090. PMID 21343168.
  8. Barrett JH, Brennan P, Fiddler M, Silman AJ (June 1999). "Does rheumatoid arthritis remit during pregnancy and relapse postpartum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy". Arthritis Rheum. 42 (6): 1219–27. doi:10.1002/1529-0131(199906)42:6<1219::AID-ANR19>3.0.CO;2-G. PMID 10366115.
  9. Louati K, Berenbaum F (October 2015). "Fatigue in chronic inflammation - a link to pain pathways". Arthritis Res. Ther. 17: 254. doi:10.1186/s13075-015-0784-1. PMC 4593220. PMID 26435495.
  10. Nikolaus S, Bode C, Taal E, van de Laar MA (July 2013). "Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review". Arthritis Care Res (Hoboken). 65 (7): 1128–46. doi:10.1002/acr.21949. PMID 23335492.
  11. Enge Junior DJ, Fonseca EKUN, Castro ADAE, Baptista E, Santos DDCB, Rosemberg LA (2019). "Avascular necrosis: radiological findings and main sites of involvement - pictorial essay". Radiol Bras. 52 (3): 187–192. doi:10.1590/0100-3984.2017.0151. PMC 6561372 Check |pmc= value (help). PMID 31210694.


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