Mechanical diagnosis and therapy and Morton’s neuroma: a case-series

ABSTRACT

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.

KEYWORDS:

• McKenzie
• mechanical diagnosis and therapy
• metatarsalgia
• Morton’s neuroma
• extremities
• MDT
• directional preference
• repeated end-range movements

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The authors have no funding details to disclose.

Notes on contributors

Michael David Post

Michael David Post is a doctor of physical therapy and holds a diploma in Mechanical Diagnosis and Therapy (MDT). He is currently a Fellow in Training for the American Academy of Orthopedic Manual Physical Therapy. He is published in the application of MDT in the presence of the medical diagnosis Morton's neuroma. He has presented a poster at an International MDT conference detailing the same case.

Joseph R. Maccio

Joseph R. Maccio is a doctor of physical therapy and holds a diploma in Mechanical Diagnosis and Therapy (MDT). He is published in the application of MDT in the wrist, hip osteoarthritis, ankle, after failed anterior cervical fusion and discectomy, and lateral epicondylagia, and further investigation of classification of MDT syndromes in the extremities. He has given a platform presentation at the McKenzie Americas Conference detailing the prevalence of directional preference at the wrist. He has also presented numerous posters at national and international MDT conferences regarding ankle, lumbar, cervical, elbow, and hip pain. He has also presented a clinical mentoring webinar for the McKenzie Institute USA on the identification of derangement and directional preference. He is the Clinical Instructor (CI) for a MDT-specific clinical rotation for doctoral physical therapy students.