Di Caprio Francesco, Meringolo Renato, Shehab Eddine Marwan, Ponziani Lorenzo
Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione 47838, Italy.
Operating Unit of Orthopedics and Traumatology, AUSL of Romagna, Ceccarini Hospital, Riccione 47838, Italy.
Foot Ankle Surg. 2018 Apr;24(2):92-98. doi: 10.1016/j.fas.2017.01.007. Epub 2017 Feb 4.
Morton's neuroma is one of the most common causes of metatarsalgia. Despite this, it remains little studied, as the diagnosis is clinical with no reliable instrumental diagnostics, and each study may deal with incorrect diagnosis or inappropriate treatment, which are difficult to verify. The present literature review crosses all key points, from diagnosis to surgical and nonoperative treatment, and recurrences. Nonoperative treatment is successful in a limited percentage of cases, but it can be adequate in those who want to delay or avoid surgery. Dorsal or plantar approaches were described for surgical treatment, both with strengths and weaknesses that will be scanned. Failures are related to wrong diagnosis, wrong interspace, failure to divide the transverse metatarsal ligament, too distal resection of common plantar digital nerve, an association of tarsal tunnel syndrome and incomplete removal. A deep knowledge of the causes and presentation of failures is needed to surgically face recurrences.
莫顿神经瘤是跖痛症最常见的病因之一。尽管如此,由于其诊断主要依靠临床判断,缺乏可靠的仪器诊断方法,且每项研究可能都存在诊断错误或治疗不当的情况,而这些又难以核实,因此该疾病仍鲜受研究。本文献综述涵盖了从诊断到手术及非手术治疗,再到复发等所有关键要点。非手术治疗仅在有限比例的病例中取得成功,但对于那些希望推迟或避免手术的患者而言可能足够。手术治疗描述了背侧或跖侧入路,二者均有优缺点,将逐一探讨。治疗失败与诊断错误、间隙选择错误、未能切断横跖韧带、足底总趾神经切除过远、跗管综合征合并以及切除不彻底有关。要通过手术应对复发情况,需要深入了解失败的原因和表现。