Coughlin Michael J, Schenck Robert C, Shurnas Paul S, Bloome David M
Foot Ankle Int. 2002 Nov;23(11):1018-25. doi: 10.1177/107110070202301109.
An interdigital neuroma is a common source of forefoot pain, and while second metatarsophalangeal joint instability is a less common entity, it can be a concomitant source of pain. The purpose of this study was to evaluate the long-term clinical course and surgical outcomes of the treatment of these concomitant problems.
121 consecutive patients (131 feet and 136 neuromas) were evaluated and treated for a symptomatic interdigital neuroma from 1981 to 1997. Of these, 24 patients (20%) had a concurrent interdigital neuroma (IDN) and second metatarsophalangeal (MTP) capsular instability that underwent surgical treatment. At the final follow-up examination, 20 patients (21 feet) were evaluated by an independent orthopaedic surgeon with a standardized clinical and radiographic examination, patient self-assessment and outcome measures.
Overall, there were 18 females and two males (21 feet) treated with an average age of 54 years at the time of surgery that returned for examination and follow-up at an average of 80 months (48 to 108 months) following surgery. Seventeen patients (85%) rated their result as good or excellent and three as fair. Six patients had mild continued symptoms referable to the second toe and none to the neuroma. Simultaneous neuroma excision and second MTP stabilization was performed in 15 cases and in six cases a staged repair was performed. The mean visual analog pain score was 1.4 (0=no pain, 10=severe pain) and mean MHAQ score was 1.13 (1-1.625) with activity modification stemming from hip, back and knee complaints.
With careful patient selection and preoperative assessment, resection of an interdigital neuroma and stabilization of second metatarsophalangeal joint instability resulted in a high percentage of successful results at greater than four years following the procedure. Objective results were comparable to previous reports on the surgical treatment of isolated interdigital neuroma and crossover second toe reconstruction. Subjective patient satisfaction was high but both subjective and objective results were lower in patients with persistent symptoms of MTP instability.
趾间神经瘤是前足疼痛的常见原因，而第二跖趾关节不稳定则较少见，但它也可能是疼痛的一个伴随来源。本研究的目的是评估这些伴随问题的长期临床病程及手术疗效。
1981年至1997年期间，对121例连续患者（131只足，136个神经瘤）进行了有症状趾间神经瘤的评估和治疗。其中，24例患者（20%）同时患有趾间神经瘤（IDN）和第二跖趾（MTP）关节囊不稳定，并接受了手术治疗。在最后一次随访检查时，由一名独立的骨科医生通过标准化的临床和影像学检查、患者自我评估及疗效指标，对20例患者（21只足）进行了评估。
总体而言，共有18名女性和2名男性（21只足）接受了治疗，手术时的平均年龄为54岁，术后平均80个月（48至108个月）返回接受检查和随访。17例患者（85%）将其结果评为良好或优秀，3例评为一般。6例患者仍有与第二趾相关的轻度持续症状，无神经瘤相关症状。15例患者同时进行了神经瘤切除和第二跖趾关节稳定术，6例患者进行了分期修复。视觉模拟疼痛评分平均为1.4（0=无疼痛，10=严重疼痛），平均MHAQ评分为1.13（1 - 1.625），活动受限源于髋部、背部和膝部问题。
通过仔细的患者选择和术前评估，切除趾间神经瘤并稳定第二跖趾关节不稳定，在术后四年以上取得了较高比例的成功结果。客观结果与先前关于孤立趾间神经瘤手术治疗和交叉第二趾重建的报道相当。患者主观满意度较高，但跖趾关节不稳定持续症状患者的主观和客观结果均较低。
