title: Metatarsalgia and Morton's Disease: Comparison of Outcomes Between Open Procedure and Neurectomy Versus Percutaneous Metatarsal Osteotomies and Ligament Release With a Minimum of 2 Years of Follow-Up.
abstract: The present study compared the clinical results of open neurectomy versus a percutaneous procedure for Morton's disease. This was a retrospective study comparing the functional results after 2 surgical procedures: open neurectomy and a percutaneous procedure (with deep transverse metatarsal ligament release and distal metatarsal osteotomies). The present study included 52 patients (26 in each group), and the mean follow-up period was 4 (range 2 to 7) years. The patient evaluation criteria included the presence of painful symptoms of Morton's disease, American Orthopaedic Foot and Ankle Society (AOFAS) functional scale score, patient satisfaction, and delay for recovery. Percutaneous treatment of Morton's disease and open neurectomy produced complete relief of pain in 25 of 26 patients in each group. At the latest follow-up visit, the mean AOFAS score had significantly improved from 36 ± 11 preoperatively to a mean of 89 ± 18 (p < .001). After 2 years, the functional improvement obtained with the percutaneous procedure persisted, with a stable AOFAS score (96 ± 10). Persistent metatarsalgia was reported by patients who had undergone open neurectomy, with a significantly decreased AOFAS score (81 ± 21, p = .009). The percutaneous procedure for Morton's disease provided excellent functional outcomes (AOFAS score >90) significantly more often with a shorter delay than after open neurectomy (p = .03). At the latest follow-up visit, metatarsalgia due to plantar hyperpressure or bursitis and requiring plantar orthotics was present in 11 of 26 patients (44%) after open neurectomy and in 1 of 26 patients (4%) after the percutaneous procedure (p = .002). Percutaneous treatment of Morton's disease is a reliable procedure providing results as good as those after open neurectomy, with significantly better outcomes in the longer term and a lower rate of late metatarsalgia.
authors.affiliation: Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France. Electronic address: thomas.bauer@apr.aphp.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Gaumetou
authors.affiliation: Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France.
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Klouche
authors.affiliation: Department of Orthopaedic Surgery, Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, Boulogne-Billancourt, France; Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hardy
authors.affiliation: Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000294:innervation; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D037061:Metatarsalgia / Q000601:surgery*; D008875:Middle Aged; D009463:Neuroma / Q000601:surgery*; D010027:Osteotomy; D017060:Patient Satisfaction; D010525:Peripheral Nerves / Q000601:surgery; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery*; D012189:Retrospective Studies
keywords: AOFAS score; Morton's neuroma; bursitis; metatarsalgia; plantar nerve