Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
BACKGROUND: We examined a large cohort of patients who had interdigital neurectomy and evaluated their clinical outcomes by using a previously developed scoring system as well as a visual analog scale (VAS). In addition, we wanted to identify risk factors that may lead to poorer outcomes.
MATERIALS AND METHODS: A retrospective review identified 232 patients who had neuroma excision between 1994 and 2004, after failure of conservative treatment. Each patient was contacted via mail and given a Neuroma Clinical Evaluation Score survey as well as a visual analog score. Each patient received a unique identification number, allowing the evaluation process to be single-blinded.
RESULTS: Of the 232 patients contacted, 120 (52%) returned their completed surveys. The average Giannini neuroma score was 53: 61 feet (51%) had good or excellent results, 12 (10%) had fair results, and 48 (40%) had poor results. The average VAS score was 2.5. The only significant (p = 0.027) difference in outcome was the location of the neuroma: second webspace had worse outcomes than third webspace neuromas on both the VAS and neuroma score.
CONCLUSION: This retrospective review identified location in the second webspace as a possible prognostic indicator of poor outcome, but the more important finding may be that outcomes of neuroma excision do not appear to be as successful at long-term followup as previously reported.
BACKGROUND: We evaluated a series of patients who underwent neurectomy or neurolysis for the surgical treatment of Morton's neuroma.
MATERIALS AND METHODS: A group of 50 patients (69 feet) who underwent surgery for a symptomatic Morton's neuroma were retrospectively reviewed. Surgery was performed through a dorsal approach in all cases. When the nerve showed macroscopic thickening or the typical pseudoneuroma, it was resected; when the nerve had no macroscopic changes, the intermetatarsal ligament and any other potentially compressive structure were released. In 17 cases, adjacent claw toes were treated.
RESULTS: Nerve thickening (pseudoneuroma) were resected in 46 cases; in the other 23 cases, the nerve was preserved. Total relief from digital nerve related symptoms was obtained in all cases but one in each group. These patients were reoperated on 6 months later by performing a neurectomy in the case where the nerve had been preserved, and a more proximal resection in the case in which the nerve had been resected. Both patients finally achieved complete pain relief.
CONCLUSION: When treating Morton's neuromas surgically, neurolysis can be a valid option when a pseudoneuroma has not developed
"second webspace had worse outcomes than third webspace neuromas ..."
Think maybe incorrect preoperative Diagnosis?
I have not seen THAT many 2nd interspace neuromas over the years, but have seen quite a few failed 2nd interspace neuromas resections!!!!
Coincidence? Maybe.
My knee jerk response would be that a certain percentage of 2nd Interspace neuromas are done NOT on neuroma patients but on patients with 2nd MTPJ pathology or even non classic Tarsal Tunnel syndromes.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
The Following User Says Thank You to drsarbes For This Useful Post:
I agree with Dr. Arbes. We are fortunate to have an excellent radiology dept. at our hospital with high end diagnostic ultrasound equipment and those experienced to read it. They frequently find an intermetatarsal bursa with no neuroma. We have them inject it under US guidance when found. They feel to the patient just like a neuroma. We also find that the US is very good at finding neuromas but not nearly as good at finding inflammatory joint changes. MRI does that better. We recently had a patient seen elsewhere and diagnosed with a 2nd space neuroma that was injected with only brief relief. An MRI showed inflammatory changes in the surrounding soft tissue and MTP joint effusion. He had only mild psoriasis but appears to have been experiencing the first signs of psoriatic arthritis. 2nd MTP joint predislocation syndrome is often misdiagnosed as a 2nd space neuroma.
I don't recall who said it first but, "The wrong operation, perfectly executed is doomed before the first incision is made."
The Following User Says Thank You to Alank For This Useful Post:
"BACKGROUND: We examined a large cohort of patients who had interdigital neurectomy and evaluated their clinical outcomes by using a previously developed scoring system as well as a visual analog scale (VAS). In addition, we wanted to identify risk factors that may lead to poorer outcomes. "
COHORT? Think they could have used a different description, perhaps sampling, population, group, "number", anything.
LARGE COHORT? I picture a large group of ex military men limping around the mall!
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Morton's neuroma is a common cause of metatarsalgia caused by intermetarsal digital nerve thickening. This study reviews the pathology, presentation, symptoms and signs, and patient satisfaction with surgical treatment. Seventy-eight patients (82 feet) were treated for Morton's metatarsalgia by excision of the interdigital nerve. The patients were followed-up for a mean of 4.6 years (range 0.8-8.1 years) and scored using the Foot Functional Index and the American Orthopedic Foot Ankle Society scoring system. In 74 patients the Foot Functional Index was more than 85 (maximum score 100). Seventy-one patients scored more than 90 on the American Orthopedic Foot Ankle Society scoring system with two patients scoring 100 (maximum score). Postoperatively, 82% reported excellent or good results, 10% had a fair result with restriction of activities or pain and 8% had no improvement at all after surgery while 71% had restrictions with footwear.
BACKGROUND: Double Morton's neuroma in one foot has rarely been reported in the literature.
METHODS: In the current study, the authors treated 11 patients with a total of 14 cases of double Morton's neuroma in one foot. During the research period, 157 cases of Morton's neuroma were treated with surgery. The neuromas were excised through a single skin incision, and all operations occurred within a 17-month period from April 2005 to October 2006.
RESULTS: The mean preoperative AOFAS score was 54 points, and the mean postoperative AOFAS score was 78 points. Seven patients underwent additional foot procedures, and the other half did not. There was no significant difference in improvement in the postoperative AOFAS score between patients treated with a combined procedure and patients treated without a combined procedure. Protective sensation was present postoperatively in most patients, except for the four patients who had hypoesthesia or hyperesthesia. No patients were administered anesthesia.
CONCLUSIONS: We report success in surgical excision of double Morton's neuroma in one foot through a single skin incision, and recommend that in cases of compound diseases, excision of a double Morton's neuroma must be performed as a combination procedure.
BACKGROUND: The choice for the surgical approach of interdigital neuroma in the foot is controversial. Plantar approach can leave a painful scar on weight bearing area; hence, some prefer dorsal approach. The aim of the current study was to measure the outcome of interdigital (Morton's) neurectomy performed by a single surgeon using dorsal and plantar approaches.
METHODS: A retrospective review of the patient records of one orthopaedic foot and ankle surgeon identified thirty-six patients (42 feet) who had been treated operatively for a primary, persistently painful interdigital neuroma. The mean follow-up was 18 months. Pain, weight bearing, wound problems and rehabilitation period were studied.
RESULTS: The duration to full weight bearing, return to work, driving and recreational activities were at least one week shorter in the dorsal group. The overall satisfaction for surgery was rated as excellent or good in 85% of the thirty six patients. Scar problems were more troublesome and common in the plantar group. There was residual numbness noticed in twenty feet, the pattern of numbness was quite variable and it was bothersome in only seven feet. There was one recurrence in the plantar group.
CONCLUSIONS: Resection of a symptomatic interdigital neuroma through a dorsal or a plantar approach can result in a good outcome. Dorsal approach, however, is associated with better rehabilitation and less scar problems.
Long-Term Results of Neurectomy in the Treatment of Morton's Neuroma: More Than 10 Years' Follow-up
Kyung Tai Lee et al
Foot Ankle Spec December 1, 2011
Quote:
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.
13 patients?
This is too small of a sample to have a study.
This is a study of patients over a two year period. If you can't come up with more than 13 patients for your study then you shouldn't be performing a study.
5 patients were satisfied with major reservations.
What the heck does that mean.
I hope my tax dollars didn't help pay for this.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Last week I saw a 62 year old man that I performed a left 3rd intermetatarsal neurectomy on over 25 years ago. He hasn't had pain in this area of his foot since the surgery and thought he thought it was a great surgery for him. Good to see these people after all these years to know that I must have been doing something right during that first year of practice.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Surgery for mortons neuroma
Linear Mode
