Plantar Versus Dorsal Incision in the Treatment of Primary Intermetatarsal Morton's Neuroma

Åkermark, Christian; Crone, Hans; Saartok, Tönu; Żuber, Zbigniew

doi:10.3113/fai.2008.0136

Cited by 46 publications

(33 citation statements)

References 19 publications

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“…The scores obtained in this study are comparative pre-operatively and very slightly lower post-operatively to their study. When the MOxFQ domains in this study are analysed further to assess the effect of surgical approach (dorsal or plantar), there was no signi cant difference across the three domains and this agrees with the ndings of Akermark et, 2008, although they did not present MOxFQ scores (7). There was also no signi cant difference between the site of the pathology (2/3 or 3/4) and the MOxFQ domain scores.…”

Section: Discussionsupporting

confidence: 83%

Interdigital Perineural Fibroma And A Care Pathway.

Price¹,

Bridgen²

2020

Preprint

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BackgroundInterdigital perineural fibroma (IPF) is a complex condition affecting the plantar nerve of the foot and the care pathway for its management is based upon a consensus of clinical opinions. AimThe aim of the study was to investigate the treatment outcomes within a podiatric surgical practice and produce a validated care pathway over a three-year period.MethodsA retrospective mixed methods design was used to allow combination of quantitative and qualitative data. 89 patients between 1/4/2014 and 1/4/2017 had completed PASCOM-10 audit data. The treatment options were investigated and the MOXFQ domains and PSQ10 outcome scores were subject to analysis with SPSS.FindingsThe mean age of patients in the study was 56 (range 36-86, SD 10.85) and 89% were female, 11% male. 749 patients out of the total caseload had local anaesthetic/steroid injections over the three-year period, of which 49% of the known injections were for Morton’s Neuroma. No outcome data was recorded for injections.89 patients went forward for surgical excision of the IPF. The surgical approach for excision was either dorsal (60.7%) or plantar (39.3%). All plantar incisions (transverse and linear) were analysed as a group for comparison against the dorsal approach. Using an independent t-test, there was no significant difference for dorsal or plantar approach or location of IPF across the three MOxFQ domains and PSQ10.Using a Pearson product moment correlation coefficient there was a moderately strong correlation between the PSQ10 and the MOxFQ domains (n=89, Walking and Standing: r=0.48, p<0.01; Pain: r=0.42, p<0.01; Social Interaction: r=0.40, p<0.01). Where increases in MOxFQ outcome score (amount of improvement) produces higher PSQ10 scores (greater patient satisfaction).ConclusionsMore audit data is required to assess the effectiveness of steroid and / or alcohol injections. Recommendation for practice is based on literature review. The surgical outcomes would suggest that the excision of IPF is an appropriate and effective technique and the surgical approach or location of pathology will not affect the clinical outcomes. A new care pathway for the management of IPF (Morton’s Neuroma) will be employed in practice and

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Section: Discussionsupporting

confidence: 83%

Interdigital Perineural Fibroma And A Care Pathway.

Price¹,

Bridgen²

2020

Preprint

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“…Approach can be dorsal or plantar. No significant difference was found between two approaches [7]. Many surgeons use dorsal approach for primary case and planter approach for revision cases.…”

Section: Discussionmentioning

confidence: 90%

Morton’s Neuroma; Surgical Exploration Is an Option in Symptomatic Patients with Normal Investigation

Ali¹,

Siddiqi²

2018

OJO

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Morton neuroma is well described problem to metatarsophalangeal Joint (MTPJ) Etiology of Morton's Neuroma which has wide range of problems from trauma, and nerve hypertrophy etc. Clinical evaluation is very important for diagnosis and sometimes investigations like ultrasound or MRI scan are helpful for conformation of diagnosis. Management varies from orthotics, shoe modification, injections or surgical excision. We are reporting a case which showed importance of surgical exploration when investigation is normal and difficulty in making diagnosis clinically.

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“… 3 However, they did not alleviate the symptoms, and therefore, multiple surgical treatments were considered. 6 7 8 9 10 11 Each method of treatment has its merits, as well as its drawbacks. 6…”

Section: Discussionmentioning

confidence: 99%

Morton’s Neuroma (Interdigital Neuralgia) Treated with Metatarsal Sliding Osteotomy

Kim

Lee

Chu³

et al. 2017

IJOO

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Background:Morton's neuroma is a common cause of metatarsalgia and many treatments had been described in literature. However, there have been only a few reports that treat the neuroma with an osteotomy on the proximal, not distal portion of the metatarsal bone using a plate. This study describes the clinical outcome of sliding osteotomy on the proximal metatarsal bone for the treatment of Morton's neuroma.Materials and Methods:Sixty five consecutive patients (85 feet) who underwent surgery for Morton's neuroma between November 2010 and February 2013 were identified from hospital records to include in this retrospective study. Average followup period was 37.3 months (range 24–51 months). Mean patient age at surgery was 50.2 years (range 23–75 years). Metatarsal sliding osteotomies were only performed on the third metatarsal bone. Clinical evaluations with the American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal Interphalangeal Scale (AOFAS LMIS) and Foot Function Index (FFI) were performed. The length of the lesser toe was measured for radiologic evaluation.Results:Postoperatively, AOFAS LMIS and FFI were improved from 52.1 (range 45–60) and 62.4 (range 54–73) to 74.2 (range 68–86) and 31.3 (range 26–37). At the last followup, preoperative pain was dissolved in 79 feet (93% of overall 85 feet). A shortened 3.2 mm (±1.1) metatarsal bone following osteotomy was radiographically measured. There were six cases of complications (soft tissue infection, early numbness, delayed union, limitation of dorsiflexion and metal failure, etc.).Conclusions:This proximal metatarsal sliding osteotomy can be a relatively effective operative method in relieving pain from Morton's neuroma.

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Plantar Versus Dorsal Incision in the Treatment of Primary Intermetatarsal Morton's Neuroma

Cited by 46 publications

References 19 publications

Interdigital Perineural Fibroma And A Care Pathway.

Interdigital Perineural Fibroma And A Care Pathway.

Morton’s Neuroma; Surgical Exploration Is an Option in Symptomatic Patients with Normal Investigation

Morton’s Neuroma (Interdigital Neuralgia) Treated with Metatarsal Sliding Osteotomy

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