Neurectomy versus Neurolysis for Morton's Neuroma

Villas, Carlos; Flórez, Borja; Alfonso, Matías

doi:10.3113/fai.2008.0578

Cited by 49 publications

(25 citation statements)

References 6 publications

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“…Operative strategies range from neurectomy or neurolysis to neuroma excision with mobilization and burial of the proximal nerve. 5,6,22,23,28 Neurectomy and neurolysis have failed to yield durable pain relief, and extensive nerve mobilization for transposition and burial necessitates greater operative morbidity. 6,19,29 An ideal approach would limit the operative field to the site of injury, simplify intraoperative decision making, provide durable pain relief, and offer the potential to restore sensation.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts

et al. 2016

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Background:Localized nerve pain in the foot and ankle can be a chronic source of disability after trauma and has been identified as the most common complication following operative interventions in the foot and ankle. The superficial location of the injured nerves and lack of suitable tissue for nerve implantation make this pain refractory to conventional methods of neuroma management. We describe a novel strategy for management using processed nerve allografts to bridge nerve gaps created by resection of both end neuromas and neuromas-in-continuity.Methods:A retrospective review of a prospectively maintained database was performed of all patients who received a processed nerve allograft for treatment of painful neuromas in the foot and ankle between May 2010 and June 2015. Patient demographic and operative information was obtained, as well as preoperative and postoperative pain assessments using a conventional ordinal scale and PROMIS (Patient Reported Outcomes Measurement Information System) Pain Behavior and Pain Interference assessments. Twenty-two patients were identified, with postoperative pain assessments occurring at a mean of 15.5 months after surgery.Results:Neuromas of the sural and superficial peroneal nerves were the most common diagnoses, with 3-cm nerve allografts being used as the interposition graft in the majority of cases. Eight patients had end neuromas and 18 patients had neuromas in continuity. Analysis of paired data demonstrated a mean ordinal pain score decrease of 2.6, with 24 and 31 percentage-point decreases in PROMIS Pain Behavior and Pain Interference measures, respectively. All changes were significant (P < .002).Conclusion:The painful sequelae of superficial nerve injuries in the foot and ankle was significantly improved with complete excision of the involved nerve segment followed by bridging of the resulting nerve gap with a processed nerve allograft. This approach limits surgery to the site of injury and reconstitutes the peripheral nerve anatomy.Level of Evidence:Level IV, retrospective case series.

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Section: Introductionmentioning

confidence: 99%

Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts

et al. 2016

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“…Assessing complaints about recurrences of the symptoms measured in a long-term follow-up may provide the answer to this question. The initial treatment of metarsalgia is mainly conservative [1][2][3]18] and includes the use of pads and orthopedic shoes, rehabilitation, and steroid and anesthetic injections [27,[29][30][31]. Makki et al [32] concluded that a single ultrasound-guided corticosteroid injection results in generally short-term pain relief for symptomatic Morton's neuromas.…”

Section: Discussionmentioning

confidence: 99%

“…If conservative methods fail, surgery should be performed, in which case there is a choice between neurolysis [18,19] and neurectomy through a dorsal approach [8,20,21] or a plantar approach [22][23][24].…”

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confidence: 99%

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

et al. 2016

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“…Da die Narbe an der Fußsohle bei Belastung des Fußes störend ist, und wegen der postoperativ erforderlichen stationären Behandlung, findet der dorsale Zugang zunehmend Verbreitung (Hassouna und Singh 2005). Villas et al (2008) fanden keinen Unterschied zwischen Dekompression und Resektion. Alternativ wurde von Gauthier (1979) eine Spaltung des Intermetatarsalbandes ohne Neuromresektion empfohlen, die wir gelegentlich durchgeführt haben, wenn kein eindeutiges Morton-Neurom erkennbar war.…”

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Nervenkompressionssyndrome

2015

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Neurectomy versus Neurolysis for Morton's Neuroma

Abstract: When treating Morton's neuromas surgically, neurolysis can be a valid option when a pseudoneuroma has not developed.

Cited by 49 publications

References 6 publications

Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts

Treatment of Foot and Ankle Neuroma Pain With Processed Nerve Allografts

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

Nervenkompressionssyndrome

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