title: Long-Term Results of Neurectomy Through a Dorsal Approach in the Treatment of Morton's Neuroma.
abstract: BACKGROUND
  Morton's neuroma, a painful enlargement of the plantar digital nerve between the metatarsal heads, is a common cause of metatarsalgia. The etiology and treatment are still a controversial matter.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the long-term follow-up results of neurectomy through a dorsal approach and to identify prognostic factors that can affect the final outcome.
  
  
  METHODS
  The study included 41 patients who were treated for Morton's neuroma. Their average age was 44 years (range: 25-69 years). The average follow-up time was 7.4 years (range: 5-12 years). Surgery was performed through a dorsal approach. The clinical evaluations, visual analog scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were assessed.
  
  
  RESULTS
  The mean preoperative AOFAS score was 39.4 ± 7.84 and the mean postoperative AOFAS score was 83.4 ± 12.1. The mean preoperative VAS scale was 7.04 ± 1.4 and the mean postoperative VAS scale was 1.4 ± 0.8. There were 31 patients (76%) with very good results in the subjective and objective patient assessments; six (15%) had good results; one (2%) had satisfactory results and three (7%) had poor results. Statistically significant differences in the results between single and multiple neuromas were found, depending on the size of the neuromas and the duration of the symptoms. There were no statistically significant differences depending on the time between surgery and assessment, on steroid injections before operation or on the duration of preoperative conservative treatment.
  
  
  CONCLUSIONS
  Despite the development of less invasive techniques and very good outcomes in a short period of time, long-term results have shown that neurectomy is still useful in the treatment of Morton's neuroma. The results of the study show that the outcome does not change during the postoperative follow-up period. The best results were achieved in the case of single neuromas larger than 3 mm that were resected within 12 months of the onset of symptoms.
authors.affiliation: Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Reichert
authors.affiliation: Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zimmer
authors.affiliation: Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Witkowski
authors.affiliation: Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Wnukiewicz
authors.affiliation: Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kuliński
authors.affiliation: Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Gosk
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000070607:Morton Neuroma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D020127:Recovery of Function; D013979:Tibial Nerve / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Morton’s neuroma; metatarsalgia; neurectomia