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Scientific Articles   |    
Plantar Approach for Excision of a Morton NeuromaA Long-Term Follow-up Study
Caio Nery, MD1; Fernando Raduan, MD1; Angelo Del Buono, MD2; Inacio Diogo Asaumi, MD1; Nicola Maffulli, MD, MS, PhD, FRCS(Orth)3
1 Department of Orthopaedic Surgery, Federal University of São Paulo, R. Pedro de Toledo 783, Fifth Floor, Vila Mariana, São Paulo, São Paulo, Brazil 04039-032. E-mail address for C. Nery: caionery@uol.com.br. E-mail address for F. Raduan: fernando@raduan.com.br. E-mail address for I.D. Asaumi: igasaumi@uol.com.br
2 Department of Orthopaedic and Trauma Surgery, Campus Biomedico, Via Alvaro del Portillo, 200, 00128 Trigoria Rome, Italy. E-mail address: a.delbuono@unicampus.it
3 Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. E-mail address: n.maffulli@qmul.ac.uk
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  • Disclosure statement for author(s): PDF

Investigation performed at the Department of Orthopaedic Surgery, Federal University of São Paulo, São Paulo, Brazil, and the Centre for Sports and Exercise Medicine, Queen Mary University of London, London, England



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Apr 04;94(7):654-658. doi: 10.2106/JBJS.K.00122
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Abstract

Background: 

When nonsurgical treatment of a Morton neuroma is unsuccessful, neurectomy is indicated. The purpose of the present retrospective study was to evaluate the long-term outcomes, complications, and adverse events following a distal plantar transverse incision for the excision of an intermetatarsal neuroma.

Methods: 

We conducted a retrospective review of 168 consecutive patients who underwent surgical excision of a Morton neuroma that had been unresponsive to nonsurgical treatment. The clinical diagnosis was confirmed by means of magnetic resonance imaging and histological analysis. All patients underwent excision of the neuroma through a distal transverse plantar approach; concomitant foot and ankle disorders were also treated. Postoperatively, a three-grade patient satisfaction scale was administered to assess the results of the procedure and a clinical examination was performed for all patients.

Results: 

One hundred and sixty patients (204 feet, 227 neuromas) were assessed at a median of 7.1 ± 3.9 years (range, one to twenty-one years) postoperatively. A good result was reported for 143 patients (89.4%); a fair result, for eleven (6.9%); and a poor result, for six (3.8%). The eleven patients with a fair result reported scar-related symptoms such as skin hardening, loss of sensation at the incision site, discomfort wearing shoes with high heels, and local paresthesias with no recurrence of the neuroma. The six patients with a poor result reported pain and paresthesias, and the recurrence of a neuroma was confirmed at the time of reoperation.

Conclusions: 

Producing a marked reduction in pain and high overall patient satisfaction, a distal transverse plantar incision is comparable with other surgical approaches for the surgical treatment of a Morton neuroma.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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