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Abstract

Background:

Morton’s neuroma is a frequent cause of metatarsalgia. Operative treatment is indicated if nonoperative management has failed. The objective of the present study was to describe a technique of Morton’s neuroma excision by a minimally invasive commissural approach and evaluate the long-term outcome and complications.

Methods:

A retrospective study of 108 patients with Morton’s neuroma treated surgically with a commissural approach between September 1990 and December 2010 was performed. The surgical technique is described. Clinical outcomes and complications were evaluated. The average follow-up was 121 months. Eleven patients were men and 97 women. The average age was 49.4 years; 56.8% neuromas were at the third space and 43.2% at the second space. Six patients presented 2 neuromas in the same foot, and 9 patients had bilateral neuroma.

Results:

The visual analog scale (VAS) average pain score was 5.4 points preoperatively and 0.2 points at the final follow-up. The author found a significant difference between the VAS scores preoperatively and postoperatively (P < .01). Excellent and good satisfaction outcomes were achieved in 93.6%. The postoperative complication incidence was 3%.

Conclusion:

The author believes a minimally invasive commissural approach has advantages over a dorsal or plantar incision. It is a simple and reproducible technique, with satisfactory outcomes, low complication rates, and a quick return to usual activities.

Level of Evidence:

Level IV, retrospective case series.

Keywords

Morton neuroma minimally invasive surgery metatarsalgia interdigital neuroma commissural approach

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References

Åkermark

Crone

Saartok

Zuber

Plantar versus dorsal incision in the treatment of primary intermetatarsal Morton’s neuroma. Foot Ankle Int. 2008;29(2):136-141.

Åkermark

Crone

Skoog

Weidenhielm

A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton’s neuroma. Foot Ankle Int. 2013;34(9);1198-1204.

Amis

Siverhus

Liwnicz

BH.

An anatomic basis for recurrence after Morton’s neuroma excision. Foot Ankle Int. 1992;13(3):153-156.

Barroco

Apostólico Netto

Nery

CAS

. Tratamento do neuroma de Morton pela via plantar: avaliação dos resultados cirúrgicos [Morton’s neuroma treatment through plantar port: retrospective assessment of surgical outcomes]. Rev Bras Ortop. 1998;33:532-536.

Bencardino

Rosenberg

Beltran

Liu

Marty-Delfaut

Morton’s neuroma: is it always symptomatic?

AJR Am J Roentgenol. 2000;175:649-653.

Benedetti

Baxter

Davis

PF.

Clinical results of simultaneous adjacent interdigital neurectomy in the foot. Foot Ankle Int. 1996;17(5):264-268.

Beskin

Baxter

DE.

Recurrent pain following interdigital neurectomy—a plantar approach. Foot Ankle Int. 1988;9(1):34-39.

Bossley

Cairney

PC.

The intermetatarsophalangeal bursa—its significance in Morton’s metatarsalgia. J Bone Joint Surg Br. 1980;62-B(2):184-187.

Bucknall

Rutherford

MacDonald

Shalaby

McKinley

Breusch

SJ.

Outcomes following excision of Morton’s interdigital neuroma: a prospective study. Bone Joint J. 2016;98-B(10):1376-1381.

10.

Civinini

. Su di un nervoso gangliare rigonfiamento della pianta del piede. Lettera anatomica al Dr. Salomone Lampronti [On a nervous ganglion swelling of the sole of the foot. Anatomical letter to Dr. Salomone Lampronti]. Mem Chir Archiespedale Pistoia. 1835:4-17.

11.

Coughlin

Pinsonneault

Operative treatment of interdigital neuroma: a long-term follow-up study. J Bone Joint Surg Am. 2001;83-A(9):1321-1328.

12.

Durlacher

Treatise on Corns, Bunions, the Diseases of Nails and the General Management of the Feet. Simpkin-Marshall; 1845.

13.

Espinoza

Schmitt

Saupe

, et al. Morton neuroma: MR imaging after resection- postoperative MRI and histologic findings in asymptomatic and symptomatic metatarsal spaces. Radiology. 2010;255:850-856.

14.

Friscia

Strom

Parr

Saltzman

Johnson

KA.

Surgical treatment for primary interdigital neuroma. Orthopaedics. 1991;14:669-672.

15.

Giannini

Bacchini

Ceccarelli

Vannini

Interdigital neuroma: clinical examination and histopathologic results in 63 cases treated with excision. Foot Ankle Int. 2004;25(2):79-84.

16.

Guiloff

Scadding

Klenerman

Morton’s metatarsalgia: clinical, electrophydiolicgical and histological observations. J Bone Joint Surg Br. 1984;66:586-591.

17.

Habashy

Sumarriva

Treuting

RJ.

Neurectomy outcomes in patients with Morton’s neuroma: comparison of plantar vs dorsal approaches. Ochsner J. 2016;16(4):471-474.

18.

Jarde

Trinquier

Pleyber

Meire

Vives

Treatment of Morton’s neuroma by neurectomy. A review of 43 cases. Rev. Chir. Orthop. 1995;81:142-146.

19.

Kundert

H-P

Plaass

Stukenborg-Colsman

Waizy

Excision of Morton’s neuroma using a longitudinal plantar approach. Foot Ankle Spec. 2015;9(1):37-42.

20.

Lee

Kim

Huh

, et al. Morton neuroma: evaluated with ultrasonography and MR imaging. Korean J Radiol. 2007;8:148-155.

21.

Lelievre

Pathologie du pied [Pathology of the foot]. Masson; 1967.

22.

Likert

A technique for the measurement of attitudes. Arch Psychol. 1932;140:5-55.

23.

Lobato

Vilela

Fernandes

ARC

Turrini

Natour

Valor do diagnóstico por imagem na avaliação do neuroma de Morton [Value of imaging diagnosis in the evaluation of Morton’s neuroma]. Rev Bras Reumatol. 2001;41:188-190.

24.

Mann

Reynolds

JD.

Interdigital neuroma—a critical clinical analysis. Foot Ankle Int. 1983;3(4):238-243.

25.

Morton

TG.

A peculiar and painful affection of the fourth metatarso-phalangeal articulation. Am J Med Sci. 1876;71:371-345.

26.

Nashi

Venkatachalam

Muddu

BN.

Surgery of Morton’s neuroma: dorsal or plantar approach?

J R Coll Surg Edinb. 1997;42:36-37.

27.

Nery

Raduan

Del Buono

Asaumi

I D

Maffulli

Plantar Approach for a Morton Neuroma. Surgical technique. JBJS Essent Surg Tech. 2012;2(3):e14.

28.

Nissen

KL.

Plantar digital neuritis: Morton metatarsalgia. J Bone Joint Surg Br. 1948;30:84-94.

29.

Okafor

Shergill

Angel

Treatment of Morton’s neuroma by neurolysis. Foot Ankle Int. 1997;18(5):284-287.

30.

Ottolenghi

Petracchi

Schajowicz

Metatarsalgia de Morton [Morton’s metatarsalgia]. Bol Soc Arg. 1948;XIII:262-265.

31.

Richardson

Brotzman

Graves

SC.

The plantar incision for procedures involving the forefoot: an evaluation of one hundred and fifty incisions in one hundred and fifteen patients. J Bone Joint Surg Am. 1993;75(5):726-731.

32.

Thompson

Deland

JT.

Occurrence of two interdigital neuromas in one foot. Foot Ankle Int. 1993;14(1):15-17.

33.

Viladot

Morton’s neuroma. Int Orthop. 1992;16:294-296.

34.

Weinfeld

Myerson

MS.

Interdigital neuritis: diagnosis and treatment. J Am Acad Orthop Surg. 1996;4(6):328-335.

35.

Duan

Wang

Dong

Xiang

The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton’s neuroma: a systematic review. Clin Radiol. 2015;70(4):351-358.

36.

Zanetti

Strehle

Kundert

Zollinger

Hodler

Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions. Radiology. 1999;213:583-588.

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