Department Orthopaedics, Herz Jesu Krankenhaus, Vienna, Austria.
Int Orthop. 2013 Sep;37(9):1857-61. doi: 10.1007/s00264-013-2002-6. Epub 2013 Jul 13.
Long-term results following surgical treatment of Morton neuroma are rare. The purpose of the present study was to evaluate patients after excision of Morton's neuroma at least ten years following surgery.
We performed a retrospective review of the patients' records who underwent excision of an interdigital neuroma with the clinical diagnosis of Morton's neuroma. Eighty-one patients who had undergone surgery on 98 feet were analysed at an average of 15.3 years postoperatively. In total 111 neuromas were excised, because in 13 feet more than one neuroma was identified clinically. Follow-up evaluation included physical examination and a radiographic evaluation. The interdigital neuroma clinical evaluation score and the AOFAS score were assessed.
An excellent result was reported for 44 feet (44.9 %), a good result for 31 feet (31.6 %) and a fair one for 15 feet (15,3 %). Eight feet had a poor result (8.2 %), in all of them an amputation neuroma was diagnosed. The average neuroma score was 62 points (range 20-80) and the AOFAS score 75 points (range 29-100). Sixty-one feet (62.2 %) had concomitant foot and ankle disorders not related to the primary diagnosis of Morton's neuroma. Numbness was assessed in 72 % (72 feet), a normal sensibility in 26 % (26 feet) and dyaesthesia in 1 % (one foot). The clinical outcome was not influenced by existence of sensory deficits (p = 0.646); analysis of location of neuroma showed best results for those in the third webspace. A significantly worse outcome was found in patients operated on multiple neuromas compared to single neuroma (p = 0.038).
Surgical excision of a Morton's neuroma results in good clinical results and high overall patient's satisfaction in the long term. Multiple neuromas have worse outcome than single neuromas. Sensory deficits and concomitant foot and ankles disorders are common, but do not have an influence on patient's satisfaction.
Morton 神经瘤的手术治疗后长期结果罕见。本研究的目的是评估至少在手术后 10 年接受 Morton 神经瘤切除术的患者。
我们对接受临床诊断为 Morton 神经瘤的指间神经瘤切除术的患者记录进行了回顾性分析。在平均 15.3 年的术后随访中，对 81 例患者的 98 只脚进行了分析。共切除 111 个神经瘤，因为在 13 只脚上，临床上发现了不止一个神经瘤。随访评估包括体格检查和影像学评估。评估了指间神经瘤临床评估评分和 AOFAS 评分。
44 只脚（44.9%）报告了优良结果，31 只脚（31.6%）为良好，15 只脚（15.3%）为一般。8 只脚（8.2%）结果较差，均诊断为截肢神经瘤。平均神经瘤评分为 62 分（范围 20-80），AOFAS 评分为 75 分（范围 29-100）。61 只脚（62.2%）伴有与 Morton 神经瘤原发性诊断无关的足部和踝关节疾病。感觉迟钝评估为 72%（72 只脚），正常感觉为 26%（26 只脚），感觉异常为 1%（1 只脚）。临床结果不受感觉缺失的影响（p=0.646）；对神经瘤位置的分析显示，第三蹼间的结果最佳。与单发性神经瘤相比，多发性神经瘤的手术结果较差（p=0.038）。
Morton 神经瘤的手术切除可获得良好的临床效果和患者长期满意度。多发性神经瘤比单发性神经瘤的结果差。感觉缺失和伴发的足部和踝关节疾病很常见，但对患者满意度没有影响。
