title: A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton's neuroma.
abstract: BACKGROUND
  There are a great number of studies on the outcome of surgery for Morton's neuroma. However, there is a lack of controlled trials to determine the outcome in general and for the 2 most used surgical approaches. This prospective and randomized trial studied the outcome and adverse events of resected primary Morton's neuromas, comparing plantar and dorsal incisions.
  
  
  METHODS
  Seventy-six patients were randomized to treatment with either a plantar or a dorsal incision by 2 senior surgeons. Questionnaires were evaluated and physical examinations performed at baseline and at 3 and 12 months postoperatively by the treating surgeon and at a mean of 34 months (range, 28-42 months) by an independent surgeon. The follow-up rate was 93%.
  
  
  RESULTS
  Histological examination of specimens verified resection of nerves in all cases except 1, which was in the dorsal group (artery). The main outcome variable, pain at daily activities, was significantly reduced by 96% (plantar) and 97% (dorsal) and restrictions in daily activities were reduced by 77% (plantar) and 67% (dorsal) at the final follow-up. Scar tenderness was noted by 3% (plantar) and 0% (dorsal) at the final evaluation. Clinically good results with surgery were noted in 87% (plantar) and 83% (dorsal) of cases. There were 5 complications in the plantar group and 6 in the dorsal group, with a difference in type of complications.
  
  
  CONCLUSIONS
  This study demonstrated 87% (plantar) and 83% (dorsal) clinically good outcomes and no significant differences between the procedures in regard to pain, restrictions in daily activities, and scar tenderness. However, there was a difference between the groups in the type of complications.
  
  
  METHODS
  Level I, prospective randomized trial.
authors.affiliation: Department of Orthopaedics, Läkarcentrum, Stockholm, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Akermark
authors.forename: Hans
authors.initials: H
authors.lastname: Crone
authors.forename: Anne
authors.initials: A
authors.lastname: Skoog
authors.forename: Lars
authors.initials: L
authors.lastname: Weidenhielm
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D005534:Foot Diseases / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D055815:Young Adult
keywords: MRI; RCT; plantar and dorsal incisions; primary Morton’s neuroma