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Morton's interdigital neuroma: instructional review.
Nikolaos Gougoulias1, Vasileios Lampridis1, Anthony Sakellariou1
1Frimley Health NHS Foundation Trust. Frimley Park Hospital, UK.
EFORT Open Reviews
|February 26, 2019
Summary
Morton's neuroma may be neuropathic foot pain, not a benign nerve tumor. Treatment includes conservative methods, with surgery reserved for failures, offering good results when diagnosis and technique are optimal.
Area of Science:
- Orthopedics
- Podiatry
- Neurology
Background:
- The term 'Morton's neuroma' might oversimplify a condition often presenting as neuropathic foot pain related to the interdigital nerve.
- Understanding foot and ankle pathomechanics is crucial for diagnosing conditions like metatarsalgia.
Purpose of the Study:
- To discuss the clinical presentation, diagnosis, and management of interdigital neuropathic foot pain.
- To differentiate between true neuroma and other causes of foot pain.
- To review current nonoperative and operative treatment strategies.
Main Methods:
- Review of clinical examination and diagnostic imaging for differential diagnosis.
- Discussion of nonoperative treatments including physiotherapy, injections, cryotherapy, radiofrequency ablation, and shockwave therapy.
- Analysis of surgical options, including neuroma excision and adjunctive procedures like gastrocnemius release and osteotomies.
Main Results:
- Nonoperative management is the recommended initial approach.
- Surgical intervention, primarily neuroma excision, yields good to excellent results in approximately 80% of patients when nonoperative methods fail.
- Concomitant procedures may be necessary to address underlying biomechanical issues.
Conclusions:
- Accurate diagnosis, encompassing all aspects of the patient's condition, is paramount for successful surgical outcomes.
- Optimal surgical technique is a key determinant of success in treating this condition.
- Considering the broader biomechanical context can improve surgical results.