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Is Histopathological Analysis of Interdigital Morton's Neuroma Necessary?
Ravi Kanth Mallina1, Khalid Al-Dadah1, Kirtan Patel1
1Department of Trauma & Orthopaedic Surgery, Kingston Hospital NHS Foundation Trust, London, UK.
Background:
Interdigital neuroma (IN), otherwise known as Morton's neuroma, is a common cause of metatarsalgia presenting to the elective foot and ankle clinic. Surgical excision of the IN in patients who fail to respond to nonoperative measures is considered to be the gold standard of care in many centers. The Royal College of Pathologists UK recommend that all excised interdigital Morton's neuromas are sent for formal histopathological analysis. We present a study correlating clinical and radiological diagnosis with histopathologic appearances of IN following surgical excision, and question if routine histopathological analysis is warranted.
Methods:
A retrospective study was carried out in a single center. Ninety-six operative records were reviewed to identify all the cases of IN surgically resected between January 2007 and July 2016. The histopathology result of the resected IN specimen, that had a clinical and radiological diagnosis of IN, was analyzed.
Results:
A total of 85 patients met the inclusion criteria and were included in the final analysis. We found that 100% of patients with a clinical, radiographic, and intraoperative diagnosis of a Morton's neuroma had a histopathological report confirming a Morton's interdigital neuroma.
Conclusion:
In our single-surgeon series, histopathologic diagnosis is in complete agreement with clinical and radiological diagnosis. We therefore recommend that routine histopathological analysis of IN is not necessary, saving resources and providing a cost benefit. Histopathologic examination should be reserved only in cases where intraoperative findings do not concur with clinical and radiological features.
Levels Of Evidence:
Level IV: Case series.
Insights
Routine histopathological analysis of Morton's neuroma (interdigital neuroma) following surgical excision is not necessary. Clinical and radiological diagnoses consistently align with histopathology, suggesting a cost-saving approach by reserving analysis for ambiguous cases.
Area of Science:
- Podiatric Surgery
- Orthopedic Pathology
Background:
- Interdigital neuroma (Morton's neuroma) is a frequent cause of metatarsalgia.
- Surgical excision is the gold standard for refractory cases.
- Pathological analysis is recommended by some institutions.
Purpose of the Study:
- To correlate clinical and radiological diagnoses with histopathological findings of resected Morton's neuromas.
- To evaluate the necessity of routine histopathological analysis post-surgery.
Main Methods:
- Retrospective single-center study of 96 surgical records (January 2007-July 2016).
- Analysis of histopathology results for 85 patients with a clinical and radiological diagnosis of interdigital neuroma.
- Level IV evidence: Case series.
Main Results:
- 100% concordance between clinical, radiographic, and intraoperative diagnosis and histopathological confirmation of Morton's neuroma.
- No discrepancies were found in the analyzed cohort.
Conclusions:
- Histopathological diagnosis perfectly matched clinical and radiological assessments in this series.
- Routine histopathological analysis of Morton's neuroma is deemed unnecessary, offering resource and cost benefits.
- Histopathology should be reserved for cases with intraoperative diagnostic uncertainty.
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