Informing Practice Through Evidence

Morton’s Neuroma is described as the thickening of the tissue around the nerve leading to the toes or nerve damage on the ball of the foot (Pearce and Calder, 2011). It usually affects the third and fourth toe. Some patients describe it as feeling like a fold on your shoe causing burning, stinging, sharp pain on the ball of the foot and numbness of toes. Known causes are repetitive trauma from high pressure such as high heels and sports such as running, rock climbing putting pressure on the forefoot. People with bunion, hammertoes, and high arch and flat feet are at a greater risk of having Morton’s Neuroma (Eui et al 2013).

There a few tests that can be used in diagnosis such as pressing on the forefoot for tender spot or clicking between bones. Other options of diagnosis include X-ray for any fractures which can also cause swelling, Ultra-sound which is often used for soft tissue neuromas, and MRI visualizing soft tissue even without symptoms (Eui et al 2013). Treatment options are switching to lower footwear with wider toe. Other interventions include Anti-inflammatory medicine non-steroidal such as ibuprofen and naproxen to reduce swelling and Ice massage and corticosteroids injection (Pearce and Calder 2011).

Surgery is usually one of the last options in management of Morton’s neuroma and could involve cutting nearby structure alignments or removal or cutting of the nerve. There is a series of types of surgical procedures that can be performed such as removal of the affected nerve and osteotomy of the proximal metatarsal. Eui et al (2013) prefer osteotomy as a better procedure than others as most patients record quicker recovery following the procedure which entails surgical cutting of the bone for alignment. Numerous complaints from patients regarding Morton’s Neuroma have prompted this study. The study intends to provide an effective diagnosis method to the patients following the surgery and will exploit the success rate estimation and side effects of the procedures to enable sound decision making among the patients with the conditions regarding the preferred treatment method.

This study utilizes mixed methods of research. This approach is a combination of both qualitative and quantitative methodologies. This approach uses pragmatism beliefs to evaluate success of practical application enhancing the capacity of the study to deal with problems in a practical way. The sample frame of this research is to involve about 10 patients with Morton’s Neuroma awaiting surgery and 10 patient’s post-surgery making it a total of 20 respondents. The study will gather the thoughts of the respondents, their feelings and pain before and after surgery.

It has been mentioned in the past that mixed methods produce better results with better understanding. Data will be collected in groups of two using a quantitative approach methodology. Participants will be interviewed after asking for their consent in order to adhere to the ethical considerations, and the verdict will be based on the opinion of the majority.

Data findings will be generated from the analysis of the data collected during the study. Use of the findings for a quantitative survey can produce a treatment plan. From the analysis, the findings presented will be based on information collected from the field and which meets the ethical criteria. In a study by Park (2013) 86 patients with neuromas were reviewed after they went through surgery in February 2008-March 2011. The first 46 had deep transverse metatarsal ligament release while the other 40 had acquired head shortening osteotomy. On review, osteotomy produced better results. The study revealed that success rate of Morton’s Neuroma surgery is known to be 55% to 85% with complications associated with post-surgical pain worse than the Morton’s Neuroma itself before surgery. 35% patients are known to suffer surgical pain.

Post -surgical pain is harder to treat because it is difficult to localize the pain. Patients complain of nerve degradation, scar tissue and post- surgical complications. Some struggle with foot instability through cutting of ligaments, gait problems and long- term recovery (Pearce and Cadler 2011). The lack of numerous researches undertaken to exploit this issue prompted this study. To achieve this, mixed methods of research is ideal for this kind of research because it measures the number discusses in detail how the patients feel post- surgery. This is not focused on one methodology but provides a wider and broader perspective of the research. Mixed methods provide a comprehensive understanding of the research problem. When conducting analysis using this method, the broad-range aspects and variables are conclusively covered with the blend of both descriptive and statistical analysis. On the contrary, qualitative and quantitative research are both weak separately but stronger when used together.

Qualitative research work focus on descriptive data and ignores data that might be crucial to the study though such data can only be expressed through statistical analysis. Mixed methods use both methodologies to analyze the problem giving you a broader view in the same study. In this case, mixed methods produce perspective results or the overall problem and provide additional evidence and supported findings. Mixed research methodology provides deductive and inductive findings reducing the researcher’s personal biased ideas. Among the main advantages of mixed research methods is the ability to apply four types of data collection such as triangulation allowing for data collection directly from the patient without ant third parties involved. This helps to protect the confidentiality of the data and makes patients more comfortable than to feel as if there is an audience.

Mixed methods also allows for explanatory study which helps to choose the best research approach for problems that have not had proper research like this topic in question. Furthermore, the approach embeds research which allows more than one approach to be used like qualitative and quantitative in one research. This fits with my research topic. Exploratory research depends on direct observation of a small group with a small problem and can be applied to a sample composed of a small number of people like the sample of people suffering from Morton’s Neuroma covered in this study.

Creswell and Plano Clark (2008) explicitly discuss about their thoughts on paradigms and their impact on mixed research met The anchorage of research methods on particular paradigms restricts research and is quite rigid making it difficult to change over the years. It has the potential of framing the research approach to follow the beliefs of the society and those of the researcher. Some researchers find it confusing as they struggle with the bracket to phrase mixed methods. Some think using mixed method approach is time consuming due to its requirement to collect and analyze data from a combination of two approaches resulting in expenditures of resources and money. Three research paradigms which are mixed methods, qualitative and quantitative research approach present different areas of suitability of their application. For instance, there is still ongoing dialogue about how mixed methods should be defined by researchers. Bergam, (2008) thinks that using mixed methods has some advantages when used in social sciences. Others think mixed methods are useful when analyzing information from another method or when one wants to build on findings from other research strategies.

hods (Teddlie and Tashakkai 2003). They raise concerns that are critical to the study. The use of the model model has been changed so many times throughout the years to meet what the society thinks is ideal. This has caused a lot of confusion to so many students with some regarding the concept as now unhelpful and opines that it should be replaced with mental models. David (2007) believes that both models should be built on strength than weakness.

A survey is a scientific research study that entails subjecting the population to questions for data collection and analysis. Surveys are usually conducted through administration of questionnaires which comprise of a set of questions designed by the researcher . survey paradigm of data collection and analysis has a number of limitations. First, the approach is quite limited since other vital data not included in the questions will not be captured. This approach is therefore not suitable for analysis of social events whose data may change at any time. The approach fails to count emotions and beliefs and collects superficial narrow data which does not elaborate human feelings and emotions.

Participant observation on the other hand, focuses on exploring and collecting data from groups and individuals by observation of the subjects in the course of their routine. This was not suitable for this study because the outcome is usually influenced by the researcher and biased towards the researcher’s beliefs and morals. Usually, a small -scale research utilizing this approach leads to overusing of material and too many interviews making it time consuming, and expensive. In conclusion, mixed method was suitable for this research because it’s broad, gives a wider research and a lot of answers can be explained in an objective manner.

References

• Bergam, M.2008.Advances in mixed method research: Review article,vol.3,Iss.4.pp411-413.
• Eui, H, P,Young, M, Sang, K, Ho L, and Young, G.2013.Research article. Metatarsal Shortening Osteotomy for Decompression of Morton’s Neuroma.vol34,Iss12.pp1654-1660.
• Creswell, J and Clark, P.2008. Designing and Conducting mixed methods research. Online Article.vol.12, Iss.4p 801-804.
• David, M .2007. Regained: Methodological Implications of combining Qualitative and Quantitative Methods. Journal Article, vol1 ,Iss1,p 48-76.
• Pearce J, and Calder D. 2011. Metatarsalgia: Proximal metatarsal osteotomies. Foot Ankle Clin. 16:597–608