The variation in the management of Morton's Metatarsalgia

Abstract

Background: Morton's Metatarsalgia is a painful condition and can often be debilitating. The value of surgical exicion has been doubted due to low success rate of surgical intervention. Objective: The purpose of this study is to examine the variation in the management steps of Morton's Metatarsalgia. Methods: Several surgeons from different European countries answered a questionnaire in regard to their routine management of a typical Morton's neuroma patient. Results: Twenty-five surgeons (100%) stated they would routinely elicit intermetatarsal tenderness in comparison to 14 (56%) and 10 (40%) surgeons who would routinely elicit intermetatrsal tenderness and Mulder's click, respectively. The majority of them (84%) will routinely request plain foot radiograph, while seven surgeons (28%) use ultrasound routinely. Coservative management is initiated by 16 surgeons (64%). Local injection was first line of treatment among 13 surgeons (56%). Surgical treatment is favoured by 10 surgeons (40%), while only 1 surgeon (4%) would use ultrasound-guided injection routinely. The popular surgical approach is dorsal incision (75%). If a surgical option was chosen then neurectomy is attempted by 17 (68%) surgeons. Conclusion: Considerable variation exists among continental surgeons in their initial management of a typical Morton's neuroma patient. This is probably due to lack of understanding of the true aetiology of the Morton's “neuroma”.