Minimally invasive neurectomy for Morton’s neuroma with interdigital approach. Long term results

Masaragian, Héctor; Perin, Fernando; Rega, Leonel; Ameriso, Nicolas; Mizdraji, Luciano; Coria, Hernan; Cicarella, Sabrina

doi:10.1016/j.foot.2021.101808

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…Chronic incisional pain was seen in 7.1% of patients who were treated with the plantar approach, and 5.1% showed a hypertrophied scar. Delayed wound healing was also noticed, and another study reported a 27% incidence of chronic incisional pain with planter approach [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Osteochondrolipoma of the foot treated by surgical excision: a case report and literature review

Aljassir,

Alageel,

AlShebel

et al. 2024

BMC Musculoskelet Disord

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Background Osteochondromas, classified as a new benign subtype of lipomas and characterised by chondroid and osseous differentiation, are rare lesions that have been infrequently reported in previous literature. The maxillofacial region was reported as the most frequent localization, with infrequent occurrence in the lower limb. This paper represents the first documented case report of osteochondrolipoma in the foot. Case presentation A 51-year-old male patient presented with a chief complaint of right foot pain at the plantar aspect, accompanied by the observation of swelling between the first and the second metatarsal shafts. His complaint of pain and swelling started 10 and 4 years prior, respectively. Since their onset, both symptoms have progressed in nature. Imaging revealved a large mass exhibiting a nonhomogenous composition of fibrous tissue and bony structures. Surgical intervention through total excision was indicated. Conclusion Osteochodrolipoma is a benign lesion that can affect the foot leading to decreased functionality of the foot due to the pain and swelling. Surgical excision is the recommended approach for this lesion, providing both symptomatic relief and confirmation of the diagnosis through histopathological examination.

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Section: Discussionmentioning

confidence: 99%

Osteochondrolipoma of the foot treated by surgical excision: a case report and literature review

Aljassir,

Alageel,

AlShebel

et al. 2024

BMC Musculoskelet Disord

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“…By remaining the intermetatarsal ligament intact when performing the plantar approach, metatarsal pain brought on by forefoot opening can be avoided, and a greater appearance index can be attained [ 6 , 11 , 29 ]. The plantar approach, however, resulted in a longer weight-bearing time and a significantly higher occurrence of postoperative incision infection, hematoma, and scar issues [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of surgical approach on the treatment of Morton's neuroma: a systematic review and meta‐analysis

Zhang,

Li,

Cai

et al. 2023

Journal of Foot and Ankle Research

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Background Surgical resection of Morton’s neuroma includes dorsal and plantar approaches. However, there is no consensus on the choice of approach in clinic. The purpose of this study was to conduct a systematic review and meta-analysis to compare the surgical results of dorsal and plantar approaches. Methods The literatures of PubMed, Cochrane library, Embase and Web of Science were searched on April 26th, 2023. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The data were extracted after screening the literature and evaluating the quality of the methodology included in the study. The RevMan5.4 software was used to analyze and calculate the OR value and 95% confidence interval. Results A total of 7 randomized controlled trials and comparative studies were published, of which only 5 were included. There were 158 feet via plantar approach (plantar group, PG) and 189 via dorsal approach (dorsal group, DG). There was no significant difference between PG and DG in overall adverse events, sensory problems, incision infection and deep vein thrombosis (p > 0.05). In terms of scar problems, PG showed more than DG (OR, 2.90[95%CI, 1.40 to 5.98]; p = 0.004). Other outcome indicators such as visual analogue scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were difficult to be included in the comparison. Conclusions Based on the relatively low quality and small amount of available evidence, the meta-analysis conducted produces a hypothesis that the frequency of adverse events in surgical treatment of Morton’s neuroma, dorsal approach and plantar approach may be the same, but the types are different. More high-level evidence is needed to further verify this hypothesis.

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“…As regards the plantar approach, the transected nerve ending is located in a well-protected intermuscular space, away from the weight-bearing area. In addition, forefoot splaying is avoided, since the transverse metatarsal ligament is not sectioned [24]. Kundert et al [25] reported that complications occurred in 7.1% of patients after the plantar approach was used and scar problems were described in 5.2% of patients, including delayed wound healing, hypertrophic scar formation, and inclusion cyst.…”

Section: Discussionmentioning

confidence: 99%

Plantar and dorsal approaches for excision of morton’s neuroma: a comparison study

Ning²,

Li³

et al. 2022

BMC Musculoskelet Disord

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Background Morton’s neuroma is a painful enlargement of the plantar digital nerve between the metatarsal heads that causes pain of the forefoot. Several approaches have been used to treat Morton’s neuroma, each of them having distinct advantages and disadvantages. Objectives The purpose of this study was to investigate and compare the clinical outcomes of neurectomy in the treatment of Morton’s neuroma through plantar and dorsal approaches. Materials and methods A total of 20 patients with a mean age of 48.5 ± 13.0 years (range: 19–66 years) who underwent excision of a Morton’s neuroma that did not respond to conservative treatment were retrospectively analysed from June 2014 to June 2021. All the neurectomies were performed using a plantar or dorsal approach. Outcomes were evaluated using visual analogue scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, the Foot and Ankle Ability Measure (FAAM), and complications. The appearance index (AI) was also used to assess the influence of foot appearance on the quality of life after surgery. Results Eight patients underwent neurectomy by the dorsal approach, and 12 patients underwent neurectomy by the plantar approach. The average follow-up time was 28.9 ± 12.9 months (range: 15–72 months). No statistically significant difference was found between the dorsal and plantar approach groups with respect to postoperative pain measured by the VAS score. The postoperative AOFAS scores and FAAM outcomes were not significantly different between the groups. The complications reported in the dorsal approach group were significantly less than those of the plantar group, mainly discomfort in wearing shoes. The AI of the plantar group and the dorsal group were significantly different. Conclusion The excision of the Morton’s neuroma by both the dorsal and plantar approach resulted in satisfactory outcomes. However, the foot appearance after surgery by the plantar approach had less influence on the quality of life than that using the dorsal approach. Our recommendation is that surgeons should choose the approach they are most familiar with and with which they are most confident in performing. In addition, the plantar approach is recommended if the patient needs a better appearance.

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Minimally invasive neurectomy for Morton’s neuroma with interdigital approach. Long term results

Cited by 6 publications

References 31 publications

Osteochondrolipoma of the foot treated by surgical excision: a case report and literature review

Osteochondrolipoma of the foot treated by surgical excision: a case report and literature review

Effect of surgical approach on the treatment of Morton's neuroma: a systematic review and meta‐analysis

Plantar and dorsal approaches for excision of morton’s neuroma: a comparison study

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