SLR - August 2012 - Jeff Merrill(2)
Reference: Nery C, Raduan F, Del Buono A, Asaumi ID, Maffulli N. Plantar Approach for Excision of a Morton Neuroma: A Long-Term Follow-Up Study, J Bone Joint Surg Am. 2012 Apr 4; 94(7): 654-8.
Scientific Literature Review
Reviewed by: Jeff Merrill, DPM
Residency Program: Pinnacle Health Hospitals
Podiatric Relevance:
Excision of a Morton’s neuroma is a common podiatric procedure. This is a long term study evaluating outcomes with the plantar horizontal approach on 204 feet as opposed to the classic dorsal approach, and results may alter some opinions over incision selection.
Methods:
This study, performed in Brazil and England, was a retrospective review of 168 excisions of a Morton’s neuroma. The neuromas had been treated with nonsurgical methods including shoe-wear modification, use of orthotic devices (anterior metatarsal support), and local corticosteroid injections prior to surgical resection. The authors performed an MRI on all patients to “rule out other pathology.” All operative specimens were sent for pathology to verify the presence of neuroma. The surgical approach used for every patient by the senior author was that of a plantar transverse incision. At the final visit, a three-grade satisfaction scale was filled out by each patient as well as an independent clinical examination by one of the authors not involved in the surgery.
Results:
A total of 227 neuromas were excised with some patients having multiple neuromas on a single foot and some having bilateral neuromas. The median assessment was performed at 7.1+ 3.9 years postoperatively. One-hundred-forty-three patients (89.4 percent) reported good results (no pain, no paresthesias). Eleven patients (6.9 percent) reported fair results (discomfort such as mild pain and/or paresthesias with no recurrence of neuroma). Six patients (3.8 percent) reported poor results (complications with persistent symptoms and confirmed recurrence of neuroma).
Conclusions:
Results of this study indicate that the plantar transverse incision for neuroma excision has a high patient satisfaction rate and is comparable with other surgical approaches for removal of a painful neuroma that has failed conservative therapy. The added benefits of this procedure are the ability to maintain the deep transverse ligament and direct visualization of the neuroma.