Surgical treatment of Morton's neuroma: clinical results after open excision

Kasparek, Michael S.; Schneider, W.

doi:10.1007/s00264-013-2002-6

Cited by 85 publications

(62 citation statements)

References 28 publications

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“…Although this is a relatively common problem, the general belief is that it does not influence patient satisfaction (3,6). In our study as well, 35% of the patients reported that they rarely felt mild pain in the surgery area.…”

Section: Characteristic Valuesupporting

confidence: 55%

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Dorsal Approach for Excision of Morton's Neuroma: A Midterm Follow-up Study

Çetin¹,

Sarban²,

Çetin³

2016

JAREM

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INTRODUCTIONMorton's neuroma (interdigital neuroma) is a disease characterized by pain spreading to the front foot and toes as a result of abnormal thickening of the interdigital nerves between the metatarsal heads. Chronic traumatic factors such as long term use of improper footwear are thought to cause compression of the nerve under the transverse intermetatarsal ligament and initiate an inflammatory process (1).The incidence of Morton's neuroma is higher in women. The main complaint is a burning pain that occurs between the metatarsal heads when one stands or walks for a long time that is relieved by rest or by removal of one's shoes. History and physical examination are sufficient for diagnosis. Ultrasonography and MRI can support the diagnosis by showing the lesions. The most commonly seen locations are the 3rd and 2nd intermetatarsal intervals (2).Although the results are not very successful, shoe modifications, orthesis, and conservative treatment methods such as local anesthetic and corticosteroid injections are the first recommended treatments for patients. Neuroma and the excision process of the branches (neurectomy) that are performed through dorsal or plantar approaches are the most effective treatment methods (3).Publications that indicate the function and satisfaction of patients after surgery are scarce in the literature. The aim of this study is to evaluate the outcomes of patients who underwent this surgery with a dorsal approach. METHODSNeuroma excision was performed in 23 feet of 21 patients whose forefoot pain complaints continued despite conservative treatment and in whom the presence of interdigital neuroma was demonstrated by MRI between September 2007 and December 2013. The mean age of the patients, 19 of whom were female and 2 of whom were male, was 41.1 (23 to 56). Fifteen left and 8 right feet were operated on by three experienced surgeons through a dorsal approach and similar techniques. Interventions were performed in the right and left feet of two patients in the same session. The neuroma was located in the 3 rd intermetatarsal interval in 17 feet (74%) and in the 2 nd intermetatarsal interval in 6 feet (26%) ( Table 1).In the procedures performed using a tourniquet under general anesthesia, following the 3 cm dorsal incision through the proper space, the interosseous fascia and muscle tissue were passed; after the metatarsal heads were separated using a lamina spreader, the deep transverse ligament was cut and the common digital nerve was reached (Figure 1). Excision was completed by cutting the nerve, including the neuroma tissue, 1 cm distal and 3 cm proximal to the deep transverse ligament. After lowering the tourniquet, bleeding control was performed; following the closure of the skin, a medical dressing was applied and the operation ended. The operation lasted 45 minutes on average. Elevation and rest were recommended to the patients following the first week of the operation. Sutures were removed 15 days later, and the patients were allowed to step on the ground. The purpose o...

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Section: Characteristic Valuesupporting

confidence: 55%

“…Neuroma and the excision process of the branches (neurectomy) that are performed through dorsal or plantar approaches are the most effective treatment methods (3).…”

Section: Introductionmentioning

confidence: 99%

Dorsal Approach for Excision of Morton's Neuroma: A Midterm Follow-up Study

Çetin¹,

Sarban²,

Çetin³

2016

JAREM

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“…). Pre‐operative evaluation of the forefoot is thus important: apart from allowing a search for fascial thinning, it can also rule out the bone deformities often associated with Civinini–Morton's syndrome (Kasparek & Schneider, ).…”

Section: Discussionmentioning

confidence: 99%

The role of fasciae in Civinini–Morton's syndrome

et al. 2015

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This study evaluates the pathogenetic role of the perineural connective tissue and foot fasciae in Civinini-Morton's neuroma. Eleven feet (seven male, four female; mean age: 70.9 years) were dissected to analyse the anatomy of inter-metatarsal space, particularly the dorsal and plantar fasciae and metatarsal transverse ligament (DMTL). The macrosections were prepared for microscopic analysis. Ten Civinini-Morton neuromas obtained from surgery were also analysed. Magnetic resonance images (MRIs) from 40 patients and 29 controls were compared. Dissections showed that the width of the inter-metatarsal space is established by two fibrous structures: the dorsal foot fascia and the DMTL, which, together, connect the metatarsal bones and resist their splaying. Interosseous muscles spread out into the dorsal fascia of the foot, defining its basal tension. The common digital plantar nerve (CDPN) is encased in concentric layers of fibrous and loose connective tissue, continuous with the vascular sheath and deep foot fascia. Outside this sheath, fibroelastic septa, from DMTL to plantar fascia, and little fat lobules are present, further protecting the nerve against compressive stress. The MRI study revealed high inter-individual variability in the forefoot structures, although only the thickness of the dorsal fascia represented a statistically significant difference between cases and controls. It was hypothesized that alterations in foot support and altered biomechanics act on the interosseous muscles, increasing the stiffness of the dorsal fascia, particularly at the points where these muscles are inserted. Chronic rigidity of this fascia increases the stiffness of the inter-metatarsal space, leading to entrapment of the CDPN.

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“…Kasparek et al 3 reported good clinical results, although sensory deficits were very common, fair results were found in 15% of patients and poor results in 8%. Complications after Morton surgery may require further regenerative surgical interventions.…”

Section: Discussionmentioning

confidence: 97%

Percutaneous needling of Morton�s complex: a technical note

Atilano

Martín

Iglesias

et al. 2015

MLTJ

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SummaryBackground: the Morton's complex, i.e. fibrotic mass enfolding the medial plantar nerve, the bursa and the interdigital transverse ligament in the web space, is a common cause of pain and functional disability. Conservative and operative treatments are investigated but currently the best approach to treat the Morton's complex is unknown. Methods: we describe a non-invasive, straight forward intervention consisting on multiple percutaneous punctures, shearing the fibrotic tissue in lateromedial and anteroposterior directions. The goal is to break up fibrosis occupying the intermetatarsal space thus releasing the affected nerve from the adjacent structures, there by stimulating tissue remodelling.

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Surgical treatment of Morton's neuroma: clinical results after open excision

Cited by 85 publications

References 28 publications

Dorsal Approach for Excision of Morton's Neuroma: A Midterm Follow-up Study

Dorsal Approach for Excision of Morton's Neuroma: A Midterm Follow-up Study

The role of fasciae in Civinini–Morton's syndrome

Percutaneous needling of Morton�s complex: a technical note

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