Abstract
BackgroundMorton's neuroma (MN) is a common cause of forefoot pain. After failure of conservative management, surgical procedures include neurectomy or neuroma preserving procedures; resection of deep transverse intermetatarsal ligament only (DTIML), dorsal neurolysis, dorsal nerve transposition (DNT).ObjectivesThis retrospective study evaluates the long-term results of open DNT, and it also reports anatomical variants in the plantar interdigital nerve.Material and methodsThe study included 39 patients (30 females and 9 males) who were treated for MN between 2002 and 2016.ResultsThe mean pre-operative Giannini score of 13 (0–30) improved to 61 (20–80) (p < .0001), with only 6 patients scoring less than 50 (poor). Using Coughlin’s criterion for overall satisfaction, 9 patients (23%) reported excellent, 18 patients (46%) good, 6 patients (15%) fair and 6 patients (15%) reported poor results. In the long term, 25 patients (64%) had no pain, 8 patients (20%) had mild pain, and 6 patients (16%) had severe pain. Ten patients (26%) reported normal sensitivity in their toes, 26 patients (66%) had numbness, and 3 patients (8%) reported dysesthesia in their toes. Twenty-two patients (56%) could wear fashionable shoes, 11 patients (28%) comfortable shoes, and 6 patients (16%) modified shoes. Regarding walking distance, 30 patients (77%) had no limitation, and 9 patients (23%) reported some limitation. Nineteen per cent regretted having surgery. Around 40% (17 out of 43 web spaces) showed anatomical variations in either the nerve or in the web space and we could not identify any specific risk factors in relation to the outcome.ConclusionDividing the DTIML or dorsal neurolysis should be considered as the primary surgical treatment and, if this fails, neurectomy would be an option. DNT can be considered if one is concerned about stump neuroma, but this may be technically demanding and in some patients it may not be possible.Level of Evidence: Level IV - Case Control Retrospective study.
Highlights
Morton’s neuroma is probably the most common nerve lesion in the lower limb
Dividing the deep transverse intermeta‐ tarsal ligament only (DTIML) or dorsal neurolysis should be considered as the primary surgical treatment and, if this fails, neurectomy would be an option
dorsal nerve transposition (DNT) can be considered if one is concerned about stump neuroma, but this may be technically demanding and in some patients it may not be possible
Summary
Morton’s neuroma is probably the most common nerve lesion in the lower limb. Of multifactorial aetiology, its main cause is probably chronic repetitive trauma of theKoti et al Journal of Orthopaedic Surgery and Research (2022) 17:22 interdigital nerve against the deep transverse intermetatarsal ligament (DTIML).Excessive weightbearing stress on the forefoot, caused by wearing pointed and high-heeled shoes causing hyper dorsiflexion of the metatarsophalangeal (MTP) joint, can produce microdamage by stretching of the interdigital nerve against the DTIML as it courses dorsally from the plantar aspect, close to the distal aspect of the intermetatarsal bursa [1]. Morton’s neuroma is probably the most common nerve lesion in the lower limb. Koti et al Journal of Orthopaedic Surgery and Research (2022) 17:22 interdigital nerve against the deep transverse intermetatarsal ligament (DTIML). Excessive weightbearing stress on the forefoot, caused by wearing pointed and high-heeled shoes causing hyper dorsiflexion of the metatarsophalangeal (MTP) joint, can produce microdamage by stretching of the interdigital nerve against the DTIML as it courses dorsally from the plantar aspect, close to the distal aspect of the intermetatarsal bursa [1]. Morton’s neuroma (MN) is a common cause of forefoot pain. After failure of conservative management, surgical procedures include neurectomy or neuroma preserving procedures; resection of deep transverse intermeta‐ tarsal ligament only (DTIML), dorsal neurolysis, dorsal nerve transposition (DNT)
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
