title: Excision of Morton's Neuroma Using a Longitudinal Plantar Approach: A Midterm Follow-up Study.
abstract: BACKGROUND
  Operative procedures are indicated in the treatment of Morton's neuroma (MN) when conservative therapies have been unsuccessful. A dorsal approach for neurolysis or neurectomy was strongly recommended. The aim of this case series study was to prospectively analyze the midterm clinical outcome and complications following the excision of a MN using a plantar longitudinal approach.
  
  
  METHODS
  Between September 2000 and January 2009, we included 44 patients (51 feet, 56 neuromas) in a prospective study treated by excision of a primary MN using a plantar longitudinal approach. The MN diagnosis was based on clinical symptoms, magnetic resonance imaging findings, and pain relief after infiltration of local anesthetics. Histological examinations were performed in all resected specimens. The patients returned for final follow-up at a mean of 54 (range = 12 to 99) months, comparing preoperative and postoperative perception of pain on a Visual Analogue Scale (VAS) and assessing clinical findings.
  
  
  RESULTS
  The average amount of pain, according to VAS, was 8 (range = 6-9) points preoperatively and 0.4 (range = 0-5) points at final follow-up. Complications occurred in 7.1% of interventions and scar problems in 5.2%, including delayed wound healing, hypertrophic scar formation, and inclusion cyst.
  
  
  CONCLUSIONS
  The present study shows a strong relief of pain after MN resection using a plantar longitudinal incision, coupled with a low rate of local complications. This surgical procedure seems to be a reliable choice for the excision of MN, even in cases with MN in adjacent webspaces, because it is technically simple and the plantar scar is not bothersome if properly located.
  
  
  METHODS
  Therapeutic, Level IV: Prospective, Case series.
authors.affiliation: Foot and Ankle Center, Hirslanden Clinic Zurich, Switzerland (H-PK)Department for Foot and Ankle Surgery, Orthopedic Clinic, Hannover Medical School, Hannover, Germany (CP, CSC)Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany (HW) hpkundert4foot@bluewin.ch.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Kundert
authors.affiliation: Foot and Ankle Center, Hirslanden Clinic Zurich, Switzerland (H-PK)Department for Foot and Ankle Surgery, Orthopedic Clinic, Hannover Medical School, Hannover, Germany (CP, CSC)Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany (HW).
authors.forename: Christian
authors.initials: C
authors.lastname: Plaass
authors.affiliation: Foot and Ankle Center, Hirslanden Clinic Zurich, Switzerland (H-PK)Department for Foot and Ankle Surgery, Orthopedic Clinic, Hannover Medical School, Hannover, Germany (CP, CSC)Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany (HW).
authors.forename: Christina
authors.initials: C
authors.lastname: Stukenborg-Colsman
authors.affiliation: Foot and Ankle Center, Hirslanden Clinic Zurich, Switzerland (H-PK)Department for Foot and Ankle Surgery, Orthopedic Clinic, Hannover Medical School, Hannover, Germany (CP, CSC)Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany (HW).
authors.forename: Hazibullah
authors.initials: H
authors.lastname: Waizy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000070607:Morton Neuroma / Q000175:diagnosis / Q000601:surgery*; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Morton; neurectomy; neuroma; plantar approach