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International Orthopaedics

, Volume 37, Issue 9, pp 1857–1861 | Cite as

Surgical treatment of Morton's neuroma: clinical results after open excision

  • Maximilian Kasparek
  • Wolfgang Schneider
Original Paper

Abstract

Purpose

Long-term results following surgical treatment of Morton neuroma are rare. The purpose of the present study was to evaluate patients after excision of Morton’s neuroma at least ten years following surgery.

Methods

We performed a retrospective review of the patients’ records who underwent excision of an interdigital neuroma with the clinical diagnosis of Morton’s neuroma. Eighty-one patients who had undergone surgery on 98 feet were analysed at an average of 15.3 years postoperatively. In total 111 neuromas were excised, because in 13 feet more than one neuroma was identified clinically. Follow-up evaluation included physical examination and a radiographic evaluation. The interdigital neuroma clinical evaluation score and the AOFAS score were assessed.

Results

An excellent result was reported for 44 feet (44.9 %), a good result for 31 feet (31.6 %) and a fair one for 15 feet (15,3 %). Eight feet had a poor result (8.2 %), in all of them an amputation neuroma was diagnosed. The average neuroma score was 62 points (range 20–80) and the AOFAS score 75 points (range 29–100). Sixty-one feet (62.2 %) had concomitant foot and ankle disorders not related to the primary diagnosis of Morton’s neuroma. Numbness was assessed in 72 % (72 feet), a normal sensibility in 26 % (26 feet) and dyaesthesia in 1 % (one foot). The clinical outcome was not influenced by existence of sensory deficits (p = 0.646); analysis of location of neuroma showed best results for those in the third webspace. A significantly worse outcome was found in patients operated on multiple neuromas compared to single neuroma (p = 0.038).

Conclusion

Surgical excision of a Morton’s neuroma results in good clinical results and high overall patient’s satisfaction in the long term. Multiple neuromas have worse outcome than single neuromas. Sensory deficits and concomitant foot and ankles disorders are common, but do not have an influence on patient’s satisfaction.

Keywords

Neuroma Sensory Deficit Transverse Ligament AOFAS Score Ankle Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Morton TG (1876) A peculiar and painful affection of the fourth metatarso-phalangeal articulation. Am J Med Sci 71:37–45CrossRefGoogle Scholar
  2. 2.
    Civinini F (1835) Su d’un nervoso gangliare rigonfiamento alla pianta del piede. Lettera anatomica al Dr. Salomone Lampronti, Pistoia, Tip BracaliGoogle Scholar
  3. 3.
    Durlacher L (1845) Treatise on corns, bunions, the diseases of nails and the general management of the feet. Simpkin-Marshall, LondonGoogle Scholar
  4. 4.
    Bennet GL, Graham CE, Mauldin DM (1995) Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int 16:760–763CrossRefGoogle Scholar
  5. 5.
    Graham CE, Graham DM (1984) Morton’s neuroma: a microscopic evaluation. Foot Ankle Int 5:150–153CrossRefGoogle Scholar
  6. 6.
    Lassmann G (1979) Morton’s toe: clinical, light, and electron microscopic investigations in 133 cases. Clin Orthop Relat Res 142:73–84PubMedGoogle Scholar
  7. 7.
    Gauthier G (1979) Thomas Morton’s diseases: a nerve entrapement syndrome. A new surgical technique. Clin Orthop Relat Res 142:90–92PubMedGoogle Scholar
  8. 8.
    Morscher E, Ulrich J, Dick W (2000) Morton’s intermetatarsal neuroma: morphology and histological substrate. Foot Ankle Int 21:558–562PubMedGoogle Scholar
  9. 9.
    Giannini S, Bacchini P, Ceccarelli F, Vannini F (2004) Interdigital neuroma: clinical examination and histopathologic results in 63 cases treated with excision. Foot Ankle Int 25:79–84PubMedGoogle Scholar
  10. 10.
    Coughlin MJ, Pinsonneault T (2001) Operative treatment of interdigital neuroma. A long-term follow-up study. J Bone Joint Surg Am 83:1321–1328PubMedGoogle Scholar
  11. 11.
    Mann RA, Reynolds JC (1983) Interdigital neuroma. A critical clinical analysis. Foot Ankle Int 3:238–243CrossRefGoogle Scholar
  12. 12.
    Wu KK (1996) Morton’s interdigital neuroma: a clinical review of its etiology, treatment and results. Foot Ankle Surg 35:112–119CrossRefGoogle Scholar
  13. 13.
    Nery C, Raduan F, Del Buono A, Asaumi ID, Maffulli N (2012) Plantar approach for excision of a Morton neuroma: a long term follow-up study. J Bone Joint Surg Am 94:654–658PubMedCrossRefGoogle Scholar
  14. 14.
    Dereymaeker G, Schroven I, Steenwerckx A, Stuer P (1996) Results of excision of the interdigital nerve in the treatment of Morton’s metatarsalgia. Acta Orthop Belg 62:22–25PubMedGoogle Scholar
  15. 15.
    Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN (2008) Long-term evaluation of interdigital Neuroma treated by surgical excision. Foot Ankle Int 29:574–577PubMedCrossRefGoogle Scholar
  16. 16.
    Greenfield J, Rea J, Ilfeld FW (1984) Morton’s interdigital neuroma: Indications for treatment by local injections versus surgery. Clin Orthop Relat Res 185:142–144PubMedGoogle Scholar
  17. 17.
    Coughlin MJ (2000) Common causes of pain in the forefoot in adults. J Bone Joint Surg Br 82:781–790PubMedCrossRefGoogle Scholar
  18. 18.
    Mulder JD (1951) The causative mechanism in Morton’s metatarsalgia. J Bone Joint Surg Br 33:94–95PubMedGoogle Scholar
  19. 19.
    Sharp RJ, Wade CM, Hennessy MS, Saxby TS (2003) 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 85:999–1005PubMedCrossRefGoogle Scholar
  20. 20.
    Symeonidis PD, Iselin LD, Simmons N, Fowler S, Dracopoulos G, Stavrou P (2012) Prevalence of interdigital nerve enlargements in an asymptomatic population. Foot Ankle Int 33:543–547PubMedCrossRefGoogle Scholar
  21. 21.
    Read JW, Noakes JB, Kerr D, Crichton KJ (1999) Morton’s metatarsalgia: sonographic findings and correlated histopathology. Foot Ankle Int 20:153–161PubMedCrossRefGoogle Scholar
  22. 22.
    Bencardio J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E (2000) Morton’s neuroma: Is it always symptomatic? Am J Roentgenol 175:649–653CrossRefGoogle Scholar
  23. 23.
    Rasmussen MR, Kitaoka HB, Patzer GL (1996) Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clin Orthop 326:188–193PubMedCrossRefGoogle Scholar
  24. 24.
    Espinosa N, Seybold JD, Jankauskas L, Erschbamer M (2011) Alcohol sclerosing therapy is not an effective treatment for interdigital neuroma. Foot Ankle Int 32:576–580PubMedCrossRefGoogle Scholar
  25. 25.
    Betts L (1940) Mortons metatarsalgia: neuritis of the fourth digital nerve. Med J Aust 1:514–515Google Scholar
  26. 26.
    McElvenny RT (1943) The etiology and surgical treatment of intractable pain about the fourth metatarsophalangeal joint (Morton’s toe). J Bone Joint Surg Am 25:675–679Google Scholar
  27. 27.
    Thompson CE, Gibson JNA, Martin D (2004) Interventions for the treatment of Morton’s neuroma. Cochrane Database Syst Rev (3):CD003118Google Scholar
  28. 28.
    McKeever DC (1940) Surgical approach for neuroma of plantar digital nerve (Morton’s metatarsalgia). J Bone Joint Surg Am 34:490Google Scholar
  29. 29.
    Akermark C, Saartok T, Zuber Z (2008) A prospective 2-year follow-up study of plantar incisions in the treatment of primary intermetatarsal neuromas (Morton’s neuroma). Foot Ankle Surg 14:67–73PubMedCrossRefGoogle Scholar
  30. 30.
    Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353PubMedCrossRefGoogle Scholar
  31. 31.
    Bojsen-Moller F (1978) Anatomy of the forefoot, normal and pathologic. Clin Orthop 142:10–18Google Scholar
  32. 32.
    Pace A, Scammel B, Dhar S (2010) The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop 34:511–515PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department OrthopaedicsHerz Jesu KrankenhausViennaAustria

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