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Ultrasound-Guided Decompression of the Intermetatarsal Nerve for Morton's Neuroma: A Novel Closed Surgical Technique

Alvaro Iborra-Marcos
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 DPM, PhD
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Manuel Villanueva-Martinez
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 MD, PhD
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Stephen L. Barrett
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 DPM
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Pablo Sanz-Ruiz
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 MD, PhD

Background

This study describes the technique for decompression of the intermetatarsal nerve in Morton's neuroma by ultrasound-guided surgical resection of the transverse intermetatarsal ligament. This technique is based on the premise that Morton's neuroma is primarily a nerve entrapment disease. As with other ultrasound-guided procedures, we believe that this technique is less traumatic, allowing earlier return to normal activity, with less patient discomfort than with traditional surgical techniques.

Methods

We performed a pilot study on 20 cadavers to ensure that the technique was safe and effective. No neurovascular damage was observed in any of the specimens. In the second phase, ultrasound-guided release of the transverse intermetatarsal ligament was performed on 56 patients through one small (1- to 2-mm) portal using local anesthesia and outpatient surgery.

Results

Of the 56 participants, 54 showed significant improvement and two did not improve, requiring further surgery (neurectomy). The postoperative wound was very small (1–2 mm). There were no cases of anesthesia of the interdigital space, and there were no infections.

Conclusions

The ultrasound-guided decompression of intermetatarsal nerve technique for Morton's neuroma by releasing the transverse intermetatarsal ligament is a safe, simple method with minimal morbidity, rapid recovery, and potential advantages over other surgical techniques. Surgical complications are minimal, but it is essential to establish a good indication because other biomechanical alterations to the foot can influence the functional outcome.

Institute Avanfi, Madrid, Spain.

US Neuropathy Centers LLC, Marietta, GA.

Orthopedic and Trauma Service, Gregorio Marañon Hospital, Madrid, Spain.

Corresponding author: Alvaro Iborra-Marcos, DPM, PhD, Institute Avanfi, Calle Orense 32, 1°, Madrid, 28020, Spain. (E-mail: docalvaroiborra@gmail.com)
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