Abstract
Introduction
Morton's Neuroma is routinely treated by excision of the interdigital nerve. Traditional surgery works by denervation, but the results are variable, and recurrence is common. Multiple Morton's Neuromas present a difficult clinical challenge. MR and ultrasound often demonstrate a normal nerve or an interdigital bursa. Some experts advise division of the intermetatarsal ligament rather than excision. This case series evaluates an alternative method of treatment.
Methods
Patients with a clinical diagnosis of Morton's Neuroma, with symptoms only on weight bearing, were treated with division of the intermetatarsal ligaments and Weil's osteotomies. The nerve was not excised. Patients wore a postoperative shoe for six weeks. If radiographs were satisfactory, they returned to weight bearing in a normal shoe. They were evaluated at 12 weeks with AOFAS scoring, as part of the routine clinical pathway.
Results
14 patients were treated with Weil's osteotomy, including one who had recurrence of symptoms following traditional surgery. The mean AOFAS score rose from 71 to 91. No patient had recurrent symptoms after surgery. The patient who had previously been treated with excision of the nerve also had some improvement.
Discussion
The success of this surgery in relief of symptoms in this case series raises questions about the pathology, diagnosis and treatment of Morton's Neuroma. Many MR studies find abnormal nerves in asymptomatic patients, and no neuroma in symptomatic patients. Patients have symptoms exacerbated by weight bearing, and nerve compression may play an important part in the pathophysiology. Weil's osteotomy works by decreasing the effective weight bearing in the involved rays. It is particularly useful if symptoms exist in multiple intermetatarsal areas.
Conclusions
Multiple Weil's osteotomies are an effective method for treatment of Morton's Neuroma. The basis for the traditional approach of excision of the nerve may be flawed and merits further study.
