Although the precise pathoetiology of Morton’s neuroma remains unclear, chronic nerve entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional operative management entails neuroma excision but risks unpredictable formation of stump neuroma.
Materials and methods
Medical records were examined for adult patients who failed at least 3 months of conservative treatment for symptomatic and recalcitrant Morton’s neuroma and who then underwent isolated IML decompression without neuroma resection.
Results
A total of 12 patients underwent isolated IML decompression for Morton’s neuroma with an average follow-up of 13.5 months. Visual Analog Pain Scale averaged 6.4 ± 1.8 (4-9) preoperatively and decreased to an average of 2 ± 2.1 (0-7) at final follow-up (P = .002). All patients reported significant improvement.
Conclusion
Isolated IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief, with no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation.
AdamsWRII. Morton’s neuroma. Clin Podiatr Med Surg. 2010;27:535-545.
2.
DiPretaJA.Metatarsalgia, lesser toe deformities, and associated disorders of the forefoot. Med Clin North Am. 2014;98:233-251.
3.
LarsonEEBarrettSLBattistonBMaloneyCTJrDellonAL.Accurate nomenclature for forefoot nerve entrapment: a historical perspective. J Am Podiatr Med Assoc. 2005;95:298-306.
4.
GrahamCEGrahamDM.Morton’s neuroma: a microscopic evaluation. Foot Ankle. 1984;5:150-153.
5.
ShereffMJGrandeDA.Electron microscopic analysis of the interdigital neuroma. Clin Orthop Relat Res. 1991;(271):296-299.
6.
FerkelEDavisWHEllingtonJK.Entrapment neuropathies of the foot and ankle. Clin Sports Med. 2015;34:791-801.
7.
BossleyCJCairneyPC.The intermetatarsophalangeal bursa—its significance in Morton’s metatarsalgia. J Bone Joint Surg Br. 1980;62-B:184-187.
8.
Torres-ClaramuntRGinesAPidemuntGPuigLde ZabalaS.MRI and ultrasonography in Morton’s neuroma: diagnostic accuracy and correlation. Indian J Orthop. 2012;46:321-325.
9.
OliverTBBeggsI.Ultrasound in the assessment of metatarsalgia: a surgical and histological correlation. Clin Radiol. 1998;53:287-289.
10.
ZanettiMStrehleJKZollingerHHodlerJ.Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers. Radiology. 1997;203:516-520.
11.
RaoufTRogeroRMcDonaldE, et al. Value of preoperative imaging and intraoperative histopathology in Morton’s neuroma. Foot Ankle Int. 2019;40:1032-1036.
12.
SaygiBYildirimYSaygiEKKaraHEsemenliT.Morton neuroma: comparative results of two conservative methods. Foot Ankle Int. 2005;26:556-559.
13.
RichardsonDRDeanEM.The recurrent Morton neuroma: what now?Foot Ankle Clin. 2014;19:437-449.
14.
JohnsonJEJohnsonKAUnniKK.Persistent pain after excision of an interdigital neuroma: results of reoperation. J Bone Joint Surg Am. 1988;70:651-657.
15.
ReichertPZimmerKWitkowskiJWnukiewiczWKulińskiSGoskJ.Long-term results of neurectomy through a dorsal approach in the treatment of Morton’s neuroma. Adv Clin Exp Med. 2016;25:295-302.
16.
TitleCISchonLC.Morton neuroma: primary and secondary neurectomy. J Am Acad Orthop Surg. 2008;16:550-557.
17.
KasparekMSchneiderW.Surgical treatment of Morton’s neuroma: clinical results after open excision. Int Orthop. 2013;37:1857-1861.
18.
WomackJWRichardsonDRMurphyGARichardsonEGIshikawaSN.Long-term evaluation of interdigital neuroma treated by surgical excision. Foot Ankle Int. 2008;29:574-577.
BucknallVRutherfordDMacDonaldDShalabyHMcKinleyJBreuschSJ.Outcomes following excision of Morton’s interdigital neuroma: a prospective study. Bone Joint J. 2016;98-B:1376-1381.
21.
LeeKTKimJBYoungKWParkYUKimJSJegalH.Long-term results of neurectomy in the treatment of Morton’s neuroma: more than 10 years’ follow-up. Foot Ankle Spec. 2011;4:349-353.
22.
PaceAScammellBDharS.The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop. 2009;34:511-515.
23.
GaynorRHakeDSpinnerSMTomczakRL.A comparative analysis of conservative versus surgical treatment of Morton’s neuroma. J Am Podiatr Med Assoc. 1989;79:27-30.
VitoGRTalaricoLM.A modified technique for Morton’s neuroma: decompression with relocation. J Am Podiatr Med Assoc. 2003;93:190-194.
26.
AkermarkCCroneHSkoogAWeidenhielmL.A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton’s neuroma. Foot Ankle Int. 2013;34:1198-1204.
27.
NeryCRaduanFDel BuonoAAsaumiIDMaffulliN.Plantar approach for a Morton neuroma: surgical technique. JBJS Essent Surg Tech. 2012;2:e14.
28.
StamatisEDMyersonMS.Treatment of recurrence of symptoms after excision of an interdigital neuroma: a retrospective review. J Bone Joint Surg Br. 2004;86:48-53.
29.
KimJYChoiJHParkJWangJLeeI.An anatomical study of Morton’s interdigital neuroma: the relationship between the occurring site and the deep transverse metatarsal ligament (DTML). Foot Ankle Int. 2007;28:1007-1010.
30.
GauthierG.Thomas Morton’s disease: a nerve entrapment syndrome. A new surgical technique. Clin Orthop Relat Res. 1979;(142):90-92.
31.
BauerTGaumetouEKloucheSHardyPMaffulliN.Metatarsalgia and Morton’s disease: comparison of outcomes between open procedure and neurectomy versus percutaneous metatarsal osteotomies and ligament release with a minimum of 2 years of follow-up. J Foot Ankle Surg. 2015;54:373-377.
32.
ParkEHKimYSLeeHJKohYG.Metatarsal shortening osteotomy for decompression of Morton’s neuroma. Foot Ankle Int. 2013;34:1654-1660.
33.
KubotaMOhnoRIshijimaM, et al. Minimally invasive endoscopic decompression of the intermatatarsal nerve for Morton’s neuroma. J Orthop. 2014;12(suppl 1):S101-S104.
ShapiroSL.Endoscopic decompression of the intermetatarsal nerve for Morton’s neuroma. Foot Ankle Clin. 2004;9:297-304.
38.
RatanshiIHayakawaTEGiuffreJL.Excision with interpositional nerve grafting: an alternative technique for the treatment of Morton neuroma. Ann Plast Surg. 2016;76:428-433.
