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Morton’s misnomer and Durlacher’s metatarsalgia
The Foot (1999) 9, 209 © 1999 Harcourt Publishers Ltd
HISTORY
Morton’s misnomer and Durlacher’s metatarsalgia T. W. D. Smith, S. Jones Consultant Orthopaedic Surgeons, Orthopaedic Department, Northern General Hospital, Sheffield, UK
Thomas George Morton (1835–1903) is best remembered for the eponymous neuroma. Before he described this form of neuralgia, he was a general surgeon in Philadelphia. He was obviously publicspirited, as he subsequently held office as President of the Pennsylvania Anti-vivisection Society and also became Chairman of a Committee on lunacy. In 18761 he published a paper describing eleven women and one man with metatarsalgia. He correctly made a diagnosis of the nerve being ‘bruised or pinched between the metatarsals’. Surprisingly, most of his cases were thought to be between the fourth and fifth metatarsals. Morton did not advise excision or neurolysis of the affected nerve. Some of his cases were attributed to injury and for these cases he advised ‘vigorous local blood letting, anodyne applications with long continued rest until all sensitiveness of the joint has disappeared’. He clearly felt that the metatarsophalangeal joint played a crucial role, as in chronic cases he advised that ‘no other treatment except complete excision of the irritable metatarso-phalangeal joint with the surrounding soft parts will be likely to be permanently successful’. It has often been the case with eponymous diseases that the description of an earlier author has remained unread and unrecognized. In 1845, Lewis Durlacher described very clearly the symptoms of plantar digital neuroma.2 He wrote that there was a ‘kind of neuralgia seated between the toes, but which fortunately is not very common’. In his excellent description he continues, ‘the patient complains of a severe pain between the toes, along the inside of one or the other, generally the second and third, he can seldom tell which; it extends up the leg and is increased when the toes are pressed together, more particularly after walking.’ Durlacher was able to relate the symptoms to the digital nerve and wrote,3 ‘another form of neuralgic affection occasionally attacks the plantar nerve on
the sole of the foot between the third and fourth metatarsal bones, but nearest to the third and close to the articulation with the phalanx.’ For treatment, he advised ‘the application of lateral compression, a strip of plaster about an inch wide being drawn tightly over the foot and round the sole. I believe this application acts by drawing the metatarsal bones closer, thus affording protection to the affected nerve, which when the parts are capable of expansion, is more exposed to pressure’. Durlacher does not advise surgery in either of his books. He clearly enjoyed an excellent reputation in Victorian London, as he was appointed surgeon chiropracter to the Queen. The authors would welcome further information about Lewis Durlacher, especially regarding any treatment he might have given Queen Victoria. REFERENCES 1. 2. 3.
Correspondence to: T. W. D. Smith FRCS, Consultant Orthopaedic Surgeon, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK 209
Morton T G. A peculiar and painful affection of the fourth metatarsophalangeal articulation. Am J Med Sci 1876; 71: 37. Durlacher L. Corns and Bunions. S Taylor, 2 George Yard, Drury Lane, Strand, London, 1845. Durlacher L. Treatise in Corns, Bunions, the Disease of Nails and the General Management of Feet. London: Simpkin Marshall, 1845.
HISTORY
Morton’s misnomer and Durlacher’s metatarsalgia T. W. D. Smith, S. Jones Consultant Orthopaedic Surgeons, Orthopaedic Department, Northern General Hospital, Sheffield, UK
Thomas George Morton (1835–1903) is best remembered for the eponymous neuroma. Before he described this form of neuralgia, he was a general surgeon in Philadelphia. He was obviously publicspirited, as he subsequently held office as President of the Pennsylvania Anti-vivisection Society and also became Chairman of a Committee on lunacy. In 18761 he published a paper describing eleven women and one man with metatarsalgia. He correctly made a diagnosis of the nerve being ‘bruised or pinched between the metatarsals’. Surprisingly, most of his cases were thought to be between the fourth and fifth metatarsals. Morton did not advise excision or neurolysis of the affected nerve. Some of his cases were attributed to injury and for these cases he advised ‘vigorous local blood letting, anodyne applications with long continued rest until all sensitiveness of the joint has disappeared’. He clearly felt that the metatarsophalangeal joint played a crucial role, as in chronic cases he advised that ‘no other treatment except complete excision of the irritable metatarso-phalangeal joint with the surrounding soft parts will be likely to be permanently successful’. It has often been the case with eponymous diseases that the description of an earlier author has remained unread and unrecognized. In 1845, Lewis Durlacher described very clearly the symptoms of plantar digital neuroma.2 He wrote that there was a ‘kind of neuralgia seated between the toes, but which fortunately is not very common’. In his excellent description he continues, ‘the patient complains of a severe pain between the toes, along the inside of one or the other, generally the second and third, he can seldom tell which; it extends up the leg and is increased when the toes are pressed together, more particularly after walking.’ Durlacher was able to relate the symptoms to the digital nerve and wrote,3 ‘another form of neuralgic affection occasionally attacks the plantar nerve on
the sole of the foot between the third and fourth metatarsal bones, but nearest to the third and close to the articulation with the phalanx.’ For treatment, he advised ‘the application of lateral compression, a strip of plaster about an inch wide being drawn tightly over the foot and round the sole. I believe this application acts by drawing the metatarsal bones closer, thus affording protection to the affected nerve, which when the parts are capable of expansion, is more exposed to pressure’. Durlacher does not advise surgery in either of his books. He clearly enjoyed an excellent reputation in Victorian London, as he was appointed surgeon chiropracter to the Queen. The authors would welcome further information about Lewis Durlacher, especially regarding any treatment he might have given Queen Victoria. REFERENCES 1. 2. 3.
Correspondence to: T. W. D. Smith FRCS, Consultant Orthopaedic Surgeon, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK 209
Morton T G. A peculiar and painful affection of the fourth metatarsophalangeal articulation. Am J Med Sci 1876; 71: 37. Durlacher L. Corns and Bunions. S Taylor, 2 George Yard, Drury Lane, Strand, London, 1845. Durlacher L. Treatise in Corns, Bunions, the Disease of Nails and the General Management of Feet. London: Simpkin Marshall, 1845.