[Morton metatarsalgia. Results of surgical treatment in 54 cases]

This syndrome, which involves nerve compression, is probably often overlooked and is, therefore, more frequent than supposed. It is characterized by pain of the forefoot, especially the 3rd and 4th toe, and is induced by pressure of the intermetatarsal space, or extension of the metatarsophalangeal joints. Results of the present study suggest that it can be successfully treated by surgery. Fifty-four patients--mostly women in midlife--had undergone operation by dorsal excision of the "neuroma" which had been performed under local anaesthesia in a bloodless field. Forty of the patients (74.1%) had recovered completely within an observation period of 1-6 years. Four (7.4%) demonstrated significant, and another 4, only slight improvement. In 6 cases (11.1%), surgery failed. The 6 unsuccessful cases had not exhibited any preoperative disturbance to the sensibility of the 4th toe. They showed, rather, symptoms of conversion disorder with depressive features, e.g. increased nocturnal suffering which is atypical for Morton's metatarsalgia. It is concluded that the accuracy of diagnosis according to strict criteria is decisive for surgical outcome.