Treatments for Morton's neuroma

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

Download Full-text

Multiple neuromas coexisting with rheumatoid synovitis and a rheumatoid nodule

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-90-5-252 ◽

2000 ◽

Vol 90 (5) ◽

pp. 252-255 ◽

Cited By ~ 3

Author(s):

LA Zielaskowski ◽

SJ Kruljac ◽

JJ DiStazio ◽

S Bastacky

Keyword(s):

Rare Case ◽

Relevant Literature ◽

Rheumatoid Nodule ◽

Morton’S Neuroma ◽

Forefoot Pain ◽

Rheumatoid Nodules ◽

Morton's Neuroma ◽

The Many

The authors present a rare case of multiple intermetatarsal neuromas coexisting with rheumatoid synovitis and a rheumatoid nodule. A brief review of rheumatoid nodules as a source of forefoot pain and a review of the relevant literature are provided. A rheumatoid nodule is just one of the many diagnoses that must be considered when one encounters pedal symptoms similar to those associated with Morton's neuroma.

Download Full-text

Morton's neuroma

International Orthopaedics ◽

10.1007/bf00182715 ◽

1992 ◽

Vol 16 (3) ◽

Cited By ~ 16

Author(s):

A. Viladot

Keyword(s):

Morton’S Neuroma ◽

Morton's Neuroma

Download Full-text

Morton’s Neuroma; Surgical Exploration Is an Option in Symptomatic Patients with Normal Investigation

Open Journal of Orthopedics ◽

10.4236/ojo.2018.811042 ◽

2018 ◽

Vol 08 (11) ◽

pp. 413-417

Author(s):

Syed Mohsin Ali ◽

Mujtaba Ahmed Siddiqi

Keyword(s):

Morton’S Neuroma ◽

Surgical Exploration ◽

Morton's Neuroma

Download Full-text

Isolated Intermetatarsal Ligament Release as Primary Surgical Management for Morton’s Neuroma

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00134 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0013

Author(s):

Mohamed Abdelaziz ◽

Kathryn Whitelaw ◽

Gregory Waryasz ◽

Daniel Guss ◽

Anne Johnson ◽

...

Keyword(s):

Patient Satisfaction ◽

Nerve Transection ◽

Digital Nerve ◽

Morton’S Neuroma ◽

The Past ◽

Symptom Exacerbation ◽

Morton's Neuroma ◽

Web Space ◽

Neuroma Formation

Category: Midfoot/Forefoot Introduction/Purpose: While the precise pathoetiology of Morton’s neuroma remains unclear, nerve inflammation as a result of chronic entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional surgical management involved common digital nerve transection with neuroma excision, but this procedure risks unpredictable formation of a stump neuroma and potential worsening of symptoms. Accordingly, the senior author has over the past six years espoused isolated IML release and common digital nerve decompression in lieu of nerve transection or neuroma excision as an alternative treatment strategy. We hypothesized that IML release offers effective pain relief and high patient satisfaction level as a surgical treatment for recalcitrant Morton’s neuroma without the risk of stump neuroma formation or symptom exacerbation. Methods: Medical records for all consecutive patients treated surgically with isolated single interspace IML release for symptomatic and recalcitrant Morton’s neuroma over a four year period at a large academic medical center were examined. Any adult patient with clinically diagnosed Morton’s neuroma who had failed at least three months of conservative treatment and who then underwent single-webspace IML decompression were included. Any patient who had less than three months postoperative follow up, had undergone revisional neuroma surgery, or had undergone additional procedures at the time of the IML release were excluded. Overall patient satisfaction as well as pre- and post-operative Visual Analog Pain Scale (VAS) assessments were recorded for all patients. Results: Eleven patients underwent isolated, single interspace IML decompression for Morton’s neuroma over this time frame. One of these patients had a neuroma localized to the second web space and 10 were localized to the third web space. Average follow-up was 10.8± 9 (3-32) months (Table 1). VAS pain scores averaged 6.4 ± 1.9 (4-9) preoperatively and decreased to an average of 1.5 ± 1.6 (0-5) at final follow up (P = 0.003). All patients reported significant pain improvement and an overall satisfaction with the procedure (would undergo it again). No patients returned to the operating room, there were no postoperative infection nor worsening of pain, and no other complications were reported. Conclusion: Isolated single interspace IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief and overall patient satisfaction, with few complications and no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. The authors’ collective experience with this approach has been positive enough over the past six years to result in the entire abandonment of the practice of neuroma excision in this patient population.

Download Full-text