The role of neuroinflammation in patients with Morton’s Neuroma

Research summary

Neuropathic (nerve related) pain occurs in a significant proportion of patients with a disease affecting the nervous system (neuropathy). The exact pathomechanisms of neuropathic pain and why only a subgroup develop neuropathic pain remains elusive. Over the past decade, experimental nerve injury models have highlighted the importance of neuroinflammation in the generation of neuropathic pain. Specifically, peripheral nerve injuries lead to an intraneural infiltration and activation of immune cells such as macrophages, T-Lymphocytes or dendritic cells. These cells are known to secrete inflammatory mediators, which in turn sensitise the nerve fibres with a resulting decrease in their firing thresholds. Although the evidence from animal models is compelling, the contribution of neuroinflammation to neuropathic pain in humans remains unclear. This is mainly due to the lack of access to neural tissues due to obvious ethical constraints. Morton's Neuroma is a condition in which the third common plantar digital nerve in the foot is compressed between the metatarsal bones. The management for this condition consists of either local corticosteroid injection or surgical excision of the affected digital nerve. As such, Morton Neuroma provides a unique model to study intraneural histological changes in patients with neuropathies. This project aims to examine whether intraneural inflammation in present in patients with Morton’s neuroma compared to unaffected control nerves. Furthermore, a potential correlation with histological and molecular findings with patients’ phenotype will be assessed and a potential role of preoperative neuroinflammation with postoperative recovery established. The study is a multi-centre study and Oxford will collect control data in 2 control groups: 1. Healthy controls for sensory testing and 2. patients undergoing resection of healthy neural tissues for reasons unrelated to neuropathy.

Principal Investigator

Prof Annina Schmid

Contact us

Email: gail.lang@ndorms.ox.ac.uk

IRAS number

184726