Plantar and Dorsal Approaches for Excision of Morton’s Neuroma: A Comparison Study

Abstract

Background: Morton’s neuroma is a painful enlargement of the plantar digital nerve between the metatarsal heads which cause pain of the forefoot. Several approaches have been used to treat the Morton’s neuroma, with each having distinct advantages and disadvantages.Objectives: The purpose of this study was to investigate and compare the clinical outcomes of neurectomy for the treatment of Morton’s neuroma through plantar and dorsal approaches.Material and Methods: We retrospectively analyzed 20 patients aged averagely 48.5±13.0 years(range: 19-66years) who underwent excision of a Morton’s neuroma that had been unresponsive to conservative treatment from June 2014 to June 2021. All the neurectomies were performed through either a plantar or dorsal approach. Outcomes were evaluated using visual analog scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, the Foot and Ankle Ability Measure (FAAM), and complications. We also used appearance index (AI) to assess the influence of foot appearance on quality of life after surgery.Results: 8 patients underwent neurectomy through a dorsal approach, and 12 patients underwent neurectomy through a plantar approach. The average follow-up time was 28.9±12.9 months(range: 15-72months). There were no statistically significant differences between the dorsal and plantar approach groups with respect to postoperative pain measured by VAS scores. The postoperative AOFAS scores and FAAM outcomes showed no significant differences between the groups. The complications reported in the dorsal approach group were significantly fewer than those of plantar group, mainly discomfort wearing shoes. The AI of the plantar group and the dorsal group were significant different.Conclusion: Excision of Morton’s neuroma through a dorsal or plantar approach both obtained satisfactory outcomes. But the foot appearance after surgery through a plantar approach have less influence on quality of life than a dorsal approach. We recommend that surgeons choose the approach they are most familiar with and most confident in performing. And we recommend the plantar approach if the patient have great need for the appearance.Level of Evidence: Level III, retrospective comparative case series.