D61. Management of Recurrent Morton’s Neuromas with Targeted Muscle Reinnervation

Abstract

PURPOSE: Morton’s interdigital neuroma is a common cause of severe foot pain that is detrimental to quality of life. Current operative interventions for this condition include neurolysis, decompression, or neurectomy, which may result in true neuroma formation, with failure rates reported up to 49%. The objective of this study was to evaluate the efficacy of targeted muscle reinnervation (TMR) for the treatment of Morton’s neuromas that have failed previous surgeries. METHODS: A retrospective chart review was performed between March 2018 and April 2021. Eight patients underwent TMR of the medial plantar nerve (MPN), lateral plantar nerve (LPN), and/or sensory plantar common digital nerves. All patients were non-amputees who had previously undergone surgery for Morton’s neuroma and now had recurrent symptoms. The operative techniques employed for TMR of neuromas in the foot were described, along with post-operative outcomes. RESULTS: Of the 8 patients reviewed receiving TMR for neuroma pain in the foot, all of whom had previously undergone excisions of digital nerve neuromas: 7 patients had complete or near complete resolution of their pain; 1 patient had no improvement upon follow-up. Of the successfully treated group, 4 had complete or near complete resolution of paresthesia, dysesthesia, and other neuropathic signs in the relevant nerve distribution. The remaining 3 had partial improvement of these symptoms. The mean follow-up period was 395 days. CONCLUSION: This study is the first to investigate TMR as a treatment and prevention option for the recurrence of Morton’s neuroma. Our technique revealed good clinical outcomes and no procedure-specific complications.