Reichert Paweł, Zimmer Krzysztof, Witkowski Jarosław, Wnukiewicz Witold, Kuliński Sebastian, Gosk Jerzy
Department and Clinic of Traumatology and Hand Surgery, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2016 Mar-Apr;25(2):295-302. doi: 10.17219/acem/60249.
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.
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.
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.
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.
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.
Morton神经瘤是跖骨头间足底趾神经的疼痛性增粗，是跖痛症的常见原因。其病因和治疗仍是一个有争议的问题。
本研究的目的是评估经背侧入路神经切除术的长期随访结果，并确定可影响最终结局的预后因素。
本研究纳入41例接受Morton神经瘤治疗的患者。他们的平均年龄为44岁（范围：25 - 69岁）。平均随访时间为7.4年（范围：5 - 12年）。手术通过背侧入路进行。评估临床评价、视觉模拟量表（VAS）评分和美国矫形足踝协会（AOFAS）评分。
术前AOFAS平均评分为39.4 ± 7.84，术后AOFAS平均评分为83.4 ± 12.1。术前VAS量表平均为7.04 ± 1.4，术后VAS量表平均为1.4 ± 0.8。在主观和客观患者评估中，31例（76%）结果非常好；6例（15%）结果良好；1例（2%）结果满意，3例（7%）结果差。根据神经瘤大小和症状持续时间，单发性和多发性神经瘤的结果存在统计学显著差异。根据手术与评估之间的时间、术前类固醇注射或术前保守治疗的持续时间，未发现统计学显著差异。
尽管微创技术有所发展且短期内效果良好，但长期结果表明神经切除术在治疗Morton神经瘤方面仍然有用。研究结果表明，术后随访期间结局没有变化。对于症状出现12个月内切除的大于3 mm的单发性神经瘤，取得了最佳结果。
