Abstract
Background
Morton's Neuroma is a proximal neuralgia that affects the web spaces of the toes and is currently of unknown aetiology. Currently surgical excision is considered the gold standard treatment based on RCT and cohort studies. However patient derived outcomes have not previously been assessed. We addressed these aspects with our study.
Methods
The validadated patient derived Manchester Oxford Foot and Ankle Questionnaire (MOXFQ) was used to assess patient derived outcomes of surgery prospectively. The MOXFQ enables the generation of four scores, a combined global score as well as a pain, walking and social score. Participants were asked to fill out the 16 item questionnaire prior to surgery and were followed up after a minimum of 6 months. All participants were treated with neurectomy following clinical diagnosis.
Results
3 patients (13.6%) were lost to follow up. Final Cohort: 19 feet from 17 participants (F=16, M=1), mean age of 56. The mean reduction in the total MOXFQ score was significant (p=0.001). The pre surgical mean score was 38.1 (95% confidence interval = 33.4 - 42.8) and after a mean follow up period of 20 months was 13.1 (95% confidence interval = 7.5 – 18.6). The reductions observed in the three metric scores of pain, walking and social were all significant (p=0.005, p=0.008, p=0.006 respectively). Eighty four percent of patients in the study experienced a clinically significantly improved pain domain, 95% in the walking domain and 58% in the social domain of the MOXFQ.
Conclusions
Surgical excision is an effective intervention for treating Morton's interdigital Neuroma with improvements seen in all three domains of the MOXFQ. The pain metric scores were consistent with previous studies. Neurectomy produces excellent functional improvements for patients. However patient derived social outcomes from surgical excision were slightly more modest than for those of pain and walking.
