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The role of fasciae in Civinini-Morton s syndrome
#MMPMID26467241
Stecco C
; Fantoni I
; Macchi V
; Del Borrello M
; Porzionato A
; Biz C
; De Caro R
J Anat
2015[Nov]; 227
(5
): 654-64
PMID26467241
show ga
This study evaluates the pathogenetic role of the perineural connective tissue
and foot fasciae in Civinini-Morton's neuroma. Eleven feet (seven male, four
female; mean age: 70.9 years) were dissected to analyse the anatomy of
inter-metatarsal space, particularly the dorsal and plantar fasciae and
metatarsal transverse ligament (DMTL). The macrosections were prepared for
microscopic analysis. Ten Civinini-Morton neuromas obtained from surgery were
also analysed. Magnetic resonance images (MRIs) from 40 patients and 29 controls
were compared. Dissections showed that the width of the inter-metatarsal space is
established by two fibrous structures: the dorsal foot fascia and the DMTL,
which, together, connect the metatarsal bones and resist their splaying.
Interosseous muscles spread out into the dorsal fascia of the foot, defining its
basal tension. The common digital plantar nerve (CDPN) is encased in concentric
layers of fibrous and loose connective tissue, continuous with the vascular
sheath and deep foot fascia. Outside this sheath, fibroelastic septa, from DMTL
to plantar fascia, and little fat lobules are present, further protecting the
nerve against compressive stress. The MRI study revealed high inter-individual
variability in the forefoot structures, although only the thickness of the dorsal
fascia represented a statistically significant difference between cases and
controls. It was hypothesized that alterations in foot support and altered
biomechanics act on the interosseous muscles, increasing the stiffness of the
dorsal fascia, particularly at the points where these muscles are inserted.
Chronic rigidity of this fascia increases the stiffness of the inter-metatarsal
space, leading to entrapment of the CDPN.
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