Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 2, March-April, p. 295–302

doi: 10.17219/acem/60249

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Long-Term Results of Neurectomy Through a Dorsal Approach in the Treatment of Morton’s Neuroma

Paweł Reichert1,A,B,C,D,E,F, Krzysztof Zimmer1,A,D,E,F, Jarosław Witkowski1,A,B,C,D, Witold Wnukiewicz1,A,B,C,D, Sebastian Kuliński1,A,B,C, Jerzy Gosk1,A,E,F

1 Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland

Abstract

Background. Morton’s neuroma, a painful enlargement of the plantar digital nerve between the metatarsal heads, is a common cause of metatarsalgia. The etiology and treatment are still a controversial matter.
Objectives. The objective of this study was to evaluate the long-term follow-up results of neurectomy through a dorsal approach and to identify prognostic factors that can affect the final outcome.
Material and Methods. The study included 41 patients who were treated for Morton’s neuroma. Their average age was 44 years (range: 25–69 years). The average follow-up time was 7.4 years (range: 5–12 years). Surgery was performed through a dorsal approach. The clinical evaluations, visual analog scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were assessed.
Results. The mean preoperative AOFAS score was 39.4 ± 7.84 and the mean postoperative AOFAS score was 83.4 ± 12.1. The mean preoperative VAS scale was 7.04 ± 1.4 and the mean postoperative VAS scale was 1.4 ± 0.8. There were 31 patients (76%) with very good results in the subjective and objective patient assessments; six (15%) had good results; one (2%) had satisfactory results and three (7%) had poor results. Statistically significant differences in the results between single and multiple neuromas were found, depending on the size of the neuromas and the duration of the symptoms. There were no statistically significant differences depending on the time between surgery and assessment, on steroid injections before operation or on the duration of preoperative conservative treatment.
Conclusion. Despite the development of less invasive techniques and very good outcomes in a short period of time, long-term results have shown that neurectomy is still useful in the treatment of Morton’s neuroma. The results of the study show that the outcome does not change during the postoperative follow-up period. The best results were achieved in the case of single neuromas larger than 3 mm that were resected within 12 months of the onset of symptoms.

Key words

Morton’s neuroma, metatarsalgia, neurectomia

References (36)

  1. Pace A, Scammell B, Dhar S: The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop 2010, 34, 511–515.
  2. Bardelli M, Turelli L, Scoccianti G: Definition and classification of metatarsalgia. J Foot Ankle Surg 2003, 9, 79–85.
  3. Mulder JD: The causative mechanism in Morton’s metatarsalgia. J Bone Joint Surg (Br) 1948, 33, 84–94.
  4. Bennet GL, Graham CE, Mauldin DM: Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int 1995, 16, 760–763. DOI: 10.1177/107110079501601204.
  5. Graham CE, Graham DM: Morton’s neuroma: a microscopic evaluation. Foot Ankle Int 1984, 5, 150–153. DOI: 10.1177/107110078400500308
  6. Morton TG: A pediculiar and painful affection of the fourth metatarsophalangeal articulation. Am J Med Sci 1876, 71, 37–45.
  7. Jain S, Mannan K: The diagnosis and management of Morton’s neuroma: A literature review. Foot Ankle Spec 2013, 6, 307–317.
  8. Coughlin MJ, Pinsonneault T: Operative treatment of interdigital neuroma. A long term follow up study. J Bone Joint Surg Am 2001, 83-A, 1321–1328.
  9. Symeonidis PD, Iselin LD, Simmons N, Fowler S, Dracopoulos G, Stavrou P: Prevalence of interdigital nerve enlargements in an asymptomatic population. Foot Ankle Int 2012, 33, 543–547.
  10. Owens R, Gougoulias N, Guthrie H, Sakellariou A: Morton’s neuroma: Clinical testing and imaging in in 76 feet, compared to a control group. Foot Ankle Surg 2011, 17, 197–200.
  11. Gauthier G: Thomas Morton’s disease: a nerve entrapment syndrome. A new surgical technique. Clin Orthop Relat Res 1979, 142, 90–92.
  12. Clinical Practice Guideline Forefoot Disorders Panel, Thomas JL, Blitch EL 4th, Chaney DM, Dinucci KA, Eickmeier K,Rubin LG, Stapp MD, Vanore JV: Diagnosis and treatment of forefoot disorders. Section 3. Morton’s intermetatarsal neuroma. J Foot Ankle Surg 2009, 48, 251–256. DOI: 0.1053/j.jfas.2008.12.005
  13. Bencardio J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E: Morton’s neuroma: Is it always symptomatic? Am J Roentgenol 2000, 175, 649–653.
  14. Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee JW, Suh JS: Morton neuroma: Evaluated with ultrasonography and MR imaging. Korean J Radiol 2007, 8, 148–155. DOI: 10.3348/kjr.2007.8.2.148.
  15. Sharp RJ, Wade CM, Hennessy MS, Saxby TS: The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesions on symptoms. J Bone Joint Surg Br 2003, 85, 999–1005.
  16. Xu Z, Duan X, Yu X, Wang H, Dong X, Xiang Z: The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton’s neuroma: a systematic review. Clin Radiol 2015, 70, 351–358.
  17. Rasmussen MR, Kitaoka HB, Patzer GL: Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clin Orthop 1996, 326, 188–193.
  18. Villas C, Florez B, Alfonso M: Neurectomy versus neurolysis for Morton’s neuroma. Foot Ankle Int 2008, 29, 578–580.
  19. Diebold PF, Daum B, Dang-Vu V, Litchinko M: True epineural neurolysis in Morton’s neuroma: A 5-year follow up. Orthopedics 1996, 19, 397–400.
  20. Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN: Long-term evaluation of interdigital Neuroma treated by surgical excision. Foot Ankle Int 2008, 29, 574–577.
  21. Thompson CE, Gibson JNA, Martin D: Interventions for the treatment of Morton’s neuroma. Cochrane Database Syst Rev 2004, 3, CD003118.
  22. Faraj AA, Hosur A: The outcome after using two different approaches for excision of Morton’s neuroma. Chin Med J (Engl) 2010, 123, 2195–2198.
  23. Keh R, Ballew K: Long term follow-up of Morton’s neuroma. J Foot Surg 1992, 31, 93–95.
  24. Fanucci E, Masala S, Fabiano S, Perugia D, Squillaci E, Varrucciu V, Simonetti G: Treatment of intermetatarsal Morton’s neuroma with alcohol injection under US guide: 10-month follow-up. Europ Rad 2004, 14, 514–518.
  25. Pasquali C, Vulcano E, Novario R, Varotto D, Montoli C, Volpe A: Ultrasound-guided alcohol injection for Morton’s neuroma. Foot Ankle Int 2015, 36, 55–59.
  26. Gurdezi S, White T, Ramesh P: Alcohol injection for Morton’s neuroma: A five-year follow-up. Foot Ankle Int 2013, 34, 1064–1067.
  27. Chuter GS, Chua YP, Connell DA, Blackney MC: Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skeletal Radiol 2013, 42, 107–111.
  28. Diez EM, Mas SM: Comparative results of two different techniques in the treatment of the Morton’s neuroma. The Foot 2004, 15, 14–16.
  29. Greenfield J, Rea J Jr, Ilfeld FW: Morton’s interdigital neuroma. Indications for treatment by local injections versus surgery. Clin Orthop Relat Res 1984, 185, 142–144.
  30. Dockery GL: The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections J Foot Ankle Surg 1999, 38, 403–408.
  31. Soe WM, Coughlin MJ: A critical analysis of Dudley Morton’s concept of disordered foot function. J Foot Ankle Surg 2006, 45, 147–155.
  32. Makki D, Haddad BZ, Mahmood Z, Shahid MS, Pathak S, Garnham I: Efficacy of corticosteroid injection versus size of plantar interdigital neuroma. Foot Ankle Int 2012, 33, 722–726.
  33. Musson RE, Sawhney JS, Lamb L, Wilkinson A, Obaid H: Ultrasound guided alcohol ablation of Morton’s neuroma. Foot Ankle Int 2012, 33, 196–201.
  34. Akermark C, Crone H, Skoog A, Weidenhielm L: 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.
  35. Mann RA, Reynolds JC: Interdigital neuroma – a critical clinical analysis. Foot Ankle Int 1983, 3, 238–243.
  36. Vachon P, Lemay M, Bouchard HL: Pathologic study of Morton’s neuroma. Can J Surg 1991, 34, 356–358.
© Wroclaw Medical University