Can percutaneous alcoholization of Morton’s neuroma with phenol by electrostimulation guidance be an alternative to surgical excision? Long-term results

Purpose. The objective of this retrospective study was to evaluate the long-term follow-up results of neurectomy clinical outcomes and complications in the treatment of Morton’s neuroma. Materials and methods. A total of 19 patients (19 different feet) were treated for Morton’s neuroma by excision of the interdigital nerve at our institute between May 1997 and May 1999. Thirteen (13 feet) of them were followed up. The 13 patients were female and had an average age of 43 years (range 34-54 years) at the time of the operation. The patients were followed-up for a mean of 10.5 years (range 10.0-12.2 years) and scored using the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scoring system and Visual Analogue Scale (VAS) score. Subjective satisfaction was evaluated at the final follow-up. Results. Eight patients scored more than 90 on the AOFAS forefoot scoring system. The VAS score was improved in all patients. The mean preoperative VAS score was 8.6 ± 0.8 cm (7-10) and the mean follow-up VAS score was 2.4 ± 1.8cm (0-6), which indicated no significant difference (P > .05). The final follow-up satisfaction results indicated that 4 patients were completely satisfied with the operation, 4 were satisfied with minor reservations, 5 were satisfied with major reservations, and no patient was unsatisfied. Neurectomy to treat Morton’s neuroma had a good satisfaction rate (61%). Eleven of the patients complained of numbness on the plantar aspect of the foot adjacent to the interspace, and 2 of these 11 patients complained of disability induced by severe numbness. There was a complaint of residual pain by 1 patient. There were no skin problems on the operation lesions. Conclusion. The long-term results of neurectomy clinical outcomes in Morton’s neuroma are slightly worse than the short- and mid-term results. Levels of Evidence: Therapeutic, Level IV, Retrospective case series

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Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variations

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-022-02910-2 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Manjunath Koti ◽

Nicola Maffulli ◽

Muwaffak Al-Shoaibi ◽

Michael Hughes ◽

Jack McAllister

Keyword(s):

Retrospective Study ◽

Anatomical Variations ◽

Long Term Results ◽

Walking Distance ◽

Morton’S Neuroma ◽

Level Of Evidence ◽

Morton's Neuroma ◽

Normal Sensitivity ◽

Nerve Transposition

Abstract Background 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 intermetatarsal ligament only (DTIML), dorsal neurolysis, dorsal nerve transposition (DNT). Objectives This retrospective study evaluates the long-term results of open DNT, and it also reports anatomical variants in the plantar interdigital nerve. Material and methods The study included 39 patients (30 females and 9 males) who were treated for MN between 2002 and 2016. Results The 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. Conclusion Dividing 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.

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Metastatic melanoma to the lung: Long-term results of surgical excision

The American Journal of Surgery ◽

10.1016/s0002-9610(85)80056-8 ◽

1985 ◽

Vol 149 (4) ◽

pp. 558-562 ◽

Cited By ~ 23

Author(s):

John O. Thayer ◽

Richard H. Overholt

Keyword(s):

Metastatic Melanoma ◽

Surgical Excision ◽

Long Term Results

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Interdigital Perineural Fibroma And A Care Pathway.

10.21203/rs.3.rs-32329/v1 ◽

2020 ◽

Author(s):

Mark Price ◽

Andrew Bridgen

Keyword(s):

Surgical Approach ◽

Care Pathway ◽

Treatment Options ◽

Surgical Excision ◽

Outcome Data ◽

Mixed Methods Design ◽

Morton’S Neuroma ◽

Audit Data ◽

Significant Difference ◽

Morton's Neuroma

Abstract BackgroundInterdigital perineural fibroma (IPF) is a complex condition affecting the plantar nerve of the foot and the care pathway for its management is based upon a consensus of clinical opinions. AimThe aim of the study was to investigate the treatment outcomes within a podiatric surgical practice and produce a validated care pathway over a three-year period.MethodsA retrospective mixed methods design was used to allow combination of quantitative and qualitative data. 89 patients between 1/4/2014 and 1/4/2017 had completed PASCOM-10 audit data. The treatment options were investigated and the MOXFQ domains and PSQ10 outcome scores were subject to analysis with SPSS.FindingsThe mean age of patients in the study was 56 (range 36-86, SD 10.85) and 89% were female, 11% male. 749 patients out of the total caseload had local anaesthetic/steroid injections over the three-year period, of which 49% of the known injections were for Morton’s Neuroma. No outcome data was recorded for injections.89 patients went forward for surgical excision of the IPF. The surgical approach for excision was either dorsal (60.7%) or plantar (39.3%). All plantar incisions (transverse and linear) were analysed as a group for comparison against the dorsal approach. Using an independent t-test, there was no significant difference for dorsal or plantar approach or location of IPF across the three MOxFQ domains and PSQ10.Using a Pearson product moment correlation coefficient there was a moderately strong correlation between the PSQ10 and the MOxFQ domains (n=89, Walking and Standing: r=0.48, p<0.01; Pain: r=0.42, p<0.01; Social Interaction: r=0.40, p<0.01). Where increases in MOxFQ outcome score (amount of improvement) produces higher PSQ10 scores (greater patient satisfaction).ConclusionsMore audit data is required to assess the effectiveness of steroid and / or alcohol injections. Recommendation for practice is based on literature review. The surgical outcomes would suggest that the excision of IPF is an appropriate and effective technique and the surgical approach or location of pathology will not affect the clinical outcomes. A new care pathway for the management of IPF (Morton’s Neuroma) will be employed in practice and

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ESRA19-0446 Is pulsed radiofrequency a long-term solution for morton’s neuroma (MN) originated pain? – A 10 years follow up case report

10.1136/rapm-2019-esraabs2019.264 ◽

2019 ◽

Author(s):

R Geller ◽

E Eisenberg

Keyword(s):

Case Report ◽

Pulsed Radiofrequency ◽

Morton’S Neuroma ◽

Morton's Neuroma

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Long-term results of surgical excision of conjunctival retention cyst using trypan blue with methylcellulose

American Journal of Ophthalmology Case Reports ◽

10.1016/j.ajoc.2019.01.010 ◽

2019 ◽

Vol 14 ◽

pp. 28-31 ◽

Cited By ~ 1

Author(s):

Ghada Zein El- Abedin Rajab ◽

Joseph L. Demer

Keyword(s):

Trypan Blue ◽

Surgical Excision ◽

Long Term Results ◽

Retention Cyst

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Denosumab: A potential new treatment option for recurrent Aneurysmal Bone Cyst of the spine

SICOT-J ◽

10.1051/sicotj/2019007 ◽

2019 ◽

Vol 5 ◽

pp. 10 ◽

Cited By ~ 2

Author(s):

Arvind G. Kulkarni ◽

Ankit Patel

Keyword(s):

Local Recurrence ◽

Human Monoclonal Antibody ◽

Bone Cyst ◽

Surgical Excision ◽

Long Term Results ◽

Osteolytic Lesions ◽

Short Period ◽

New Treatment

ABCs are expansile osteolytic lesions typically containing blood-filled spaces separated by fibrous septae. Standard treatment includes surgical resection or curettage and packing; however, for some spinal lesions, the standard approach is not optimal. One therapeutic strategy is to treat spinal ABC with an agent that targets a pathway that is dysregulated in a disease with similar pathophysiology. Denosumab, a human monoclonal antibody to RANKL is effective in the treatment of GCT's. Spinal ABCs are a therapeutic challenge and local recurrence is a concern. We report a case of aggressive recurrent ABC of dorsal spine in a 14-year old female with progressive neurologic deficit who underwent surgical excision and decompression with a recurrence in a short period for which a decompression and fixation was done. She had a recurrence after an asymptomatic period of 6 months and neurologic worsening. Having ruled out use of embolization and radiotherapy, a remission was achieved by treatment with Denosumab using the regimen for GCTs for a duration of 6 months. Follow-up MRI and CT scans at 24 months following inception of Denosumab depicted complete resolution and no recurrence. We conclude that Denosumab can result in symptomatic and radiological improvement in the recurrent locally aggressive ABC and may be useful in selected cases. Long-term results are mandatory to confirm the efficacy of Denosumab and to evaluate local recurrence after stopping Denosumab.

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