Fore Foot Pain: Morton Neuroma Surgery—Tips for Surgeons

Abstract

Morton’s neuroma is a mechanical neuropathy of plantar interdigital nerve. It is one of the most common causes of forefoot pain. One of the most undesirable complications of Morton’s neuroma surgery is recurrent neuroma. Excision level of Morton’s neuroma is important to prevent recurrence. In this study, we aimed to figure out preferred excision levels of orthopedic surgeons by evaluating pathological samples. Pathological specimens of 192 patients were prepared and examined by the same pathologist. One hundred thirty-nine patients were women (72.3%) and 53 were men (27.6%). The most common interspace affected was the third at 171 (89%) patients, followed by the second at 21 (11%). Mean age was 45.8 years (between 23 and 73). Twenty-two of them were left foot and the other 170 were right foot. Recurrent neuromas, pathological sample more than one piece from one surgical site, were excluded from the study. Pathological specimens were prepared and examined by the same pathologist. Gross pathological appearance and histopathological findings were recorded. Mean sample length was 2.05 cm (between 0.8 and 6 cm). One hundred forty-five samples were smaller (75.5%) than 3 cm, and only 47 samples (24.5%) were bigger than 3 cm. Our database results showed that majority of surgeons excise the nerve shorter than it should be. One of the reasons for high recurrence rates in Morton neurinoma may be inadequate excision of the nerve.