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

Nery, Caio MD; Raduan, Fernando MD; Del Buono, Angelo MD; Asaumi, Inacio Diogo MD; Maffulli, Nicola MD, MS, PhD, FRCS(Orth)

Journal of Bone & Joint Surgery - American Volume: 4 April 2012 - Volume 94 - Issue 7 - p 654–658
doi: 10.2106/JBJS.K.00122
Scientific Articles

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.

1Department of Orthopaedic Surgery, Federal University of São Paulo, R. Pedro de Toledo 783, Fifth Floor, Vila Mariana, São Paulo, São Paulo, Brazil 04039-032. E-mail address for C. Nery: caionery@uol.com.br. E-mail address for F. Raduan: fernando@raduan.com.br. E-mail address for I.D. Asaumi: igasaumi@uol.com.br

2Department of Orthopaedic and Trauma Surgery, Campus Biomedico, Via Alvaro del Portillo, 200, 00128 Trigoria Rome, Italy. E-mail address: a.delbuono@unicampus.it

3Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. E-mail address: n.maffulli@qmul.ac.uk

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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