Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea.
Department of Orthopaedic Surgery, Yonsei Gunwoo Hospital, Seoul, Republic of Korea.
J Orthop Sci. 2024 Nov;29(6):1423-1429. doi: 10.1016/j.jos.2023.10.012. Epub 2023 Nov 11.
Various operative methods for the treatment of Morton's neuroma have been discussed, and osteotomy of the metatarsal bone has been reported recently. However, there has been no report of pedobarographic changes after metatarsal osteotomy. Pedobarographic changes of other metatarsal area after the surgery may cause transfer metatarsalgia, and thorough analysis of the pedobarographic data should be performed peri-operatively. The purpose of this study is to investigate the post-operative pedobarographic changes of sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma.
Forty patients (45 feet) who underwent metatarsal sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma from November 2013 to December 2021 were retrospectively reviewed. Proximal sliding osteotomy was performed at the proximal 3rd metatarsal bone through dorsal approach. Clinical outcomes were evaluated with American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal Interphalangeal Scale (AOFAS LMIS), Foot Function Index (FFI), and Visual Analogue Scale (VAS). Plain radiograph and pedobarogram were performed to evaluate the radiologic and pedobarographic outcomes.
AOFAS score was improved from 52.8 ± 9.0 (18-62) to 88.8 ± 9.8 (78-100) and FFI was improved from 61.8 ± 4.9 (50-70) to 32.2 ± 5.1 (23-42) on average. The 3rd metatarsal bone was shortened by 3.1 ± 0.8 mm and dorsally shifted by 1.5 ± 0.4 mm after the surgery. Plantar intermetatarsal distances between 2nd and 3rd and 3rd and 4th metatarsal heads were significantly increased post-operatively. Average forefoot pressure and maximum pressure of the 2nd to 4th metatarsal head were not significantly changed between pre-operatively and post-operatively.
Proximal metatarsal sliding osteotomy of the 3rd metatarsal bone shows a satisfactory result in both clinical and pedobarographical evaluations. It could be an effective treatment of permanent indirect decompression of Morton's neuroma with avoiding recurred neuroma, adhesion of tissue, paresthesia, and transfer metatarsalgia.
目前已有多种治疗 Morton 神经瘤的手术方法被讨论，其中跖骨骨切开术也有报道。但是，跖骨骨切开术后的足底压力变化尚未见报道。其他跖骨区的足底压力变化可能导致转移性跖痛，因此需要在手术前进行全面的足底压力数据分析。本研究旨在探讨第三跖骨滑动截骨术治疗 Morton 神经瘤的术后足底压力变化。
回顾性分析 2013 年 11 月至 2021 年 12 月采用第三跖骨近端滑动截骨术治疗 Morton 神经瘤的 40 例（45 足）患者资料。经背侧入路行第三跖骨干近端滑动截骨术。采用美国矫形足踝协会小趾-跖骨-趾间关节量表（AOFAS LMIS）、足功能指数（FFI）和视觉模拟评分（VAS）评估临床疗效。拍摄标准前后位 X 线片和足底压力图，评估影像学和足底压力结果。
AOFAS 评分由术前的 52.8±9.0（18-62）分提高至术后的 88.8±9.8（78-100）分，FFI 评分由术前的 61.8±4.9（50-70）分降低至术后的 32.2±5.1（23-42）分。术后第三跖骨平均缩短 3.1±0.8mm，背侧移位 1.5±0.4mm。术后第 2、3 跖骨头和第 3、4 跖骨头之间的跖间距离明显增加。术前、后第 2-4 跖骨头的足底平均压力和最大压力无明显变化。
第三跖骨干近端滑动截骨术在临床和足底压力评估方面均取得满意疗效。它是一种有效的治疗方法，可永久性地间接减压 Morton 神经瘤，避免复发的神经瘤、组织粘连、感觉异常和转移性跖痛。
