Nerve decompression according to A.L. Dellon in Morton's neuroma - A retrospective analysis

Abstract

First reported by Dellon et al. in 1992, nerve decompression by dissecting the deep transversal intermetatarsal ligament through a dorsal incision appears to be a reliable method for treating Morton's neuroma by addressing its underlying pathomechanism, since it should rather be considered as Morton's entrapment. As there are no current studies dealing with Dellon's surgical technique, we carried out a retrospective analysis with the aim of showing that nerve decompression is an effective method to treat Morton's neuroma, and one that considers its true pathology. All patients with a clinical diagnosis of Morton's neuroma, verified by MRI and treated by nerve decompression were included in this study in the years from 2010 to 2018 at our department. Follow-up was performed at least six months post-intervention; pain and function history were ascertained using the VAS (visual analogue scale) score and the German foot function index. Skin sensitivity testing was performed using Semmes-Weinstein monofilaments. A total of 12 patients were treated and followed-up during the study period. Postoperatively, there was significant improvement in the values of the VAS score both under strain (p-value: 0.0021) and at rest (p-value: 0.0062), as well as in the foot function index (p-value: 0.0022). There was no significant difference in skin sensitivity of the innervation areas of the interdigital nerves of the affected foot compared with the healthy reference foot (p-value: 0.0968). Dellon's decompression method yielded a highly positive outcome, and based on our findings, we consider it a reliable, technically simple and promising approach to treat Morton's neuroma. It is a minimally invasive technique that addresses the pathomechanism of peripheral nerve entrapment and has a low rate of complication as well as rapid patient recovery.