Summary
The dissected plantar nerves of 105 patients with clinical symptoms of Morton's disease were examined under light and electron microscopy. Of the 105 cases, 75 showed characteristic neuronal lesions; in the others different pathologic substrates responsible for the clinical symptoms could be demonstrated. The nervous lesions are characterized by:
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1.
Thickening of the walls of the endoneurial vessels produced by multiple layers of basement membranes.
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2.
Edema and sclerosis of the endoneurium. In the electron microscope the endoneurium was filled by deposits of fibrils with a tubular substructure and a diameter of 100–110 Å.
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3.
Thickening of the perineurium.
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4.
Degeneration of the nerve fibers without signs of wallerian degeneration or obvious reactive Schwann's cell hyperplasia.
The possible pathogenetic mechanisms of Morton's disease and some clinical problems are discussed.
Zusammenfassung
In 105 Fällen von Mortonscher Metatarsalgie mit typischer klinischer Symptomatik wurden lichtoptische und in einigen auch elektronenoptische Untersuchungen ausgeführt. In 75 dieser Fälle fanden sich in den chirurgisch entfernten Anteilen des Plantarnerven die für die Krankheit typischen neurohistologischen Veränderungen, während in den restlichen Fällen den klinischen Beschwerden unterschiedliche Befunde, wie Lipome, degenerative Gefäßprozesse mit thrombembolischem Verschluß und sekundärer Degeneration der nervösen Formationen sowie andere Krankheitsprozesse zugrunde lagen.
Die typischen Veränderungen bei Mortonscher Metatarsalgie sind durch folgende Befunde im betroffenen Plantarnerven gekennzeichnet:
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1.
Verdickung der Gefäßwände im Endoneurium durch Ausbildung zahlreicher Basalmembranen.
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2.
Ödem und bindegewebige Sklerose des Endoneuriums; letztere ist elektronenoptisch durch Fibrillen mit tubulärer Substruktur und einem Durchmesser von 100–110 Å charakterisiert.
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3.
Verdickung des Perineuriums.
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4.
Degeneration der neuralen Formationen ohne Zeichen Waller'scher Degeneration im Sinne eines langsam verlaufenden Prozesses.
Die den Veränderungen zugrunde liegenden pathogenetischen Mechanismen und einige klinische Probleme werden diskutiert.
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We are greatly indebted to Miss J. Selbmann and Mrs. S. Kolassa for skilful technical assistance, to Mr. H. Wagner for preparing the photographs, and to Dr. M. Gootz for experienced technical advise.
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Lassmann, G., Lassmann, H. & Stockinger, L. Morton's metatarsalgia. Virchows Arch. A Path. Anat. and Histol. 370, 307–321 (1976). https://doi.org/10.1007/BF00445776
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DOI: https://doi.org/10.1007/BF00445776