Comparative Analysis of Dorsal Nerve Transfer vs Dorsal Neurectomy in Morton’s Neuroma

Abstract

Category:Lesser Toes, Midfoot/ForefootIntroduction/Purpose:Comparative analysis of Dorsal Nerve Transfer and Dorsal Neurectomy in Surgical management of Morton’s NeuromaMethods:This clinical audit was conducted on patients who had undergone surgery for Morton’s neuroma (MN) between 2002 and 2014. Data was collected using an in-depth review of patients’ case-notes. During the period studied, there were a total of 77 patients, 4 the DNT and 40 in the DN groups. The key indication for surgery in all cases reviewed was failure of the condition to improve using conservative methods. A telephonic survey with Primary outcome measure being Coughlin’s Overall patient’s satisfaction criteria and secondary outcome measures were resolution of sensory symptoms and any footwear restrictions.Results:The results of this clinical study shows excellent to good results with the Dorsal nerve transfer group (84%) and Dorsal neurectomy (80%). There were poor results in 11% in the DNT group and 15% in the DN group.Key advantages of Dorsal nerve transfer are better resolution of sensory symptoms in the toes (82%) when compared to Dorsal Neurectomy (65%). 7% reported Nov change and 11% were worse after surgery. 20% had no change and 15% were worse following surgery in DN group. Around 83% had no restriction wearing any footwear in the DNT group when compared to 80%. 17% in the DNT group and 20% were in the DN group wore modified or shoes with no heels.Conclusion:In general there is no significant difference in the outcome of the two surgery all procedures. Key advantages of Dorsal nerve transfer is better resolution of sensory symptoms in the toes (82%) when compared to Dorsal Neurectomy (65%). Around 83% in DNT group and 80% in DN group had no restriction wearing any footwear gain is almost similar in both groups in the DNT group. Whilst Dorsal nerve transfer is a slightly longer procedure than Dorsal neurectomy as some problems were encountered relating to mobilising the nerve due to overlying prominent blood vessels or nerve anomalies.