Plantar Approach for Excision of a Morton Neuroma: A Long-Term Follow-up Study

• Published in: Journal of bone and joint surgery. American volume 2012-04, Vol.94 (7), p.654-658
• Main Authors: Nery, Caio, Raduan, Fernando, Del Buono, Angelo, Asaumi, Inacio Diogo, Maffulli, Nicola
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Cohort Studies; Diseases of the osteoarticular system; Female; Follow-Up Studies; Forefoot, Human - pathology; Forefoot, Human - surgery; Humans; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Neuroma - pathology; Neuroma - surgery; Orthopedic Procedures - methods; Orthopedic surgery; Pain Measurement; Retrospective Studies; Risk Assessment; Severity of Illness Index; Soft Tissue Neoplasms - diagnosis; Soft Tissue Neoplasms - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.K.00122

BACKGROUND:When nonsurgical treatment of a Morton neuroma is unsuccessful, neurectomy is indicated. The purpose of the present retrospective study was to evaluate the long-term outcomes, complications, and adverse events following a distal plantar transverse incision for the excision of an intermetatarsal neuroma. METHODS:We conducted a retrospective review of 168 consecutive patients who underwent surgical excision of a Morton neuroma that had been unresponsive to nonsurgical treatment. The clinical diagnosis was confirmed by means of magnetic resonance imaging and histological analysis. All patients underwent excision of the neuroma through a distal transverse plantar approach; concomitant foot and ankle disorders were also treated. Postoperatively, a three-grade patient satisfaction scale was administered to assess the results of the procedure and a clinical examination was performed for all patients. RESULTS:One hundred and sixty patients (204 feet, 227 neuromas) were assessed at a median of 7.1 ± 3.9 years (range, one to twenty-one years) postoperatively. A good result was reported for 143 patients (89.4%); a fair result, for eleven (6.9%); and a poor result, for six (3.8%). The eleven patients with a fair result reported scar-related symptoms such as skin hardening, loss of sensation at the incision site, discomfort wearing shoes with high heels, and local paresthesias with no recurrence of the neuroma. The six patients with a poor result reported pain and paresthesias, and the recurrence of a neuroma was confirmed at the time of reoperation. CONCLUSIONS:Producing a marked reduction in pain and high overall patient satisfaction, a distal transverse plantar incision is comparable with other surgical approaches for the surgical treatment of a Morton neuroma. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.