Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variations
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 tr...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-022-02910-2 |
| _version_ | 1798041152836861952 |
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| author | Manjunath Koti Nicola Maffulli Muwaffak Al-Shoaibi Michael Hughes Jack McAllister |
| author_facet | Manjunath Koti Nicola Maffulli Muwaffak Al-Shoaibi Michael Hughes Jack McAllister |
| author_sort | Manjunath Koti |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T22:17:31Z |
| format | Article |
| id | doaj.art-9bd401b0d10b4b1fa7b288920b9a107b |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T22:17:31Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-9bd401b0d10b4b1fa7b288920b9a107b2022-12-22T04:00:19ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2022-01-011711710.1186/s13018-022-02910-2Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variationsManjunath Koti0Nicola Maffulli1Muwaffak Al-Shoaibi2Michael Hughes3Jack McAllister4Princess Royal University Hospital, Kings College Hospital NHS TrustBarts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of LondonPrincess Royal University Hospital, Kings College Hospital NHS TrustHomerton University HospitalChelsfield Park HospitalAbstract 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.https://doi.org/10.1186/s13018-022-02910-2Morton’s neuroma (MN)Dorsal nerve transposition (DNT)Dorsal nerve relocationDorsal neurectomyDorsal neurolysisDeep transverse intermetatarsal ligament (DTIML) |
| spellingShingle | Manjunath Koti Nicola Maffulli Muwaffak Al-Shoaibi Michael Hughes Jack McAllister 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 Morton’s neuroma (MN) Dorsal nerve transposition (DNT) Dorsal nerve relocation Dorsal neurectomy Dorsal neurolysis Deep transverse intermetatarsal ligament (DTIML) |
| title | Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variations |
| title_full | Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variations |
| title_fullStr | Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variations |
| title_full_unstemmed | Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variations |
| title_short | Long-term results of dorsal neuroma/nerve transposition in the surgical management of Morton’s neuroma and correlation with intraoperative anatomical variations |
| title_sort | long term results of dorsal neuroma nerve transposition in the surgical management of morton s neuroma and correlation with intraoperative anatomical variations |
| topic | Morton’s neuroma (MN) Dorsal nerve transposition (DNT) Dorsal nerve relocation Dorsal neurectomy Dorsal neurolysis Deep transverse intermetatarsal ligament (DTIML) |
| url | https://doi.org/10.1186/s13018-022-02910-2 |
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