Advertisement
-
1.
Pasero G , Marson P: & Civinini Filippo (1805-1844) and the discovery of plantar neuroma [in Italian]. Reumatismo 58 : 319, 2006.
-
2.
The Classic. A peculiar and painful affection of the fourth metatarso-phalangeal articulation. Thomas G. Morton, M.D. Clin Orthop Relat Res (142) : 4, 1979.
-
3.
Di Caprio F , Meringolo R & Shehab Eddine M et al.: Morton's interdigital neuroma of the foot: a literature review. Foot Ankle Surg 24 : 92, 2018.
-
4.
Barrett SL: Endoscopic nerve decompression. Clin Podiatr Med Surg 23 : 579, 2006.
-
5.
Peters PG , Adams SB Jr, & Schon LC: Interdigital neuralgia. Foot Ankle Clin 16 : 305, 2011.
-
6.
Jain S & Mannan K: The diagnosis and management of Morton's neuroma: a literature review. Foot Ankle Spec 6 : 307, 2013.
-
7.
Bradley N , Miller WA & Evans JP: Plantar neuroma: analysis of results following surgical excision in 145 patients. South Med J 69 : 853, 1976.
-
8.
Kasparek M & Schneider W: Surgical treatment of Morton's neuroma: clinical results after open excision. Int Orthop 37 : 1857, 2013.
-
9.
Thompson FM & Deland JT: Occurrence of two interdigital neuromas in one foot. Foot Ankle 14 : 15, 1993.
-
10.
Claassen L , Bock K & Ettinger M et al.: Role of MRI in detection of Morton's neuroma. Foot Ankle Int 35 : 1002, 2014.
-
11.
Mahadevan D , Venkatesan M & Bhatt R et al.: Diagnostic accuracy of clinical tests for Morton's neuroma compared with ultrasonography. J Foot Ankle Surg 54 : 549, 2015.
-
12.
Pastides P , El-Sallakh S & Charalambides C: Morton's neuroma: a clinical versus radiological diagnosis. Foot Ankle Surg 18 : 22, 2012.
-
13.
Richardson DR & Dean EM: The recurrent Morton neuroma: what now? Foot Ankle Clin 19 : 437, 2014.
-
14.
Xu Z , Duan X & Yu X et al.: The accuracy of ultrasonography and magnetic resonance imaging for the diagnosis of Morton's neuroma: a systematic review. Clin Radiol 70 : 351, 2015.
-
15.
Bignotti B , Signori A & Sormani MP et al.: Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol 25 : 2254, 2015.
-
16.
Santos D , Morrison G & Coda A: Sclerosing alcohol injections for the management of intermetatarsal neuromas: a systematic review. Foot (Edinb) 35 : 36, 2018.
-
17.
Chuter GS , Chua YP & Connell DA et al.: Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton's) neuroma. Skeletal Radiol 42 : 107, 2013.
-
18.
Deniz S , Purtuloglu T & Tekindur S et al.: Ultrasound-guided pulsed radio frequency treatment in Morton's neuroma. JAPMA 105 : 302, 2015.
-
19.
Zelent ME , Kane RM & Neese DJ et al.: Minimally invasive Morton's intermetatarsal neuroma decompression. Foot Ankle Int 28 : 263, 2007.
-
20.
Shapiro SL: Endoscopic decompression of the intermetatarsal nerve for Morton's neuroma. Foot Ankle Clin 9 : 297, 2004.
-
21.
Biasca N , Zanetti M & Zollinger H: Outcomes after partial neurectomy of Morton's neuroma related to preoperative case histories, clinical findings, and findings on magnetic resonance imaging scans. Foot Ankle Int 20 : 568, 1999.
-
22.
Valisena S , Petri GJ & Ferrero A: Treatment of Morton's neuroma: a systematic review. Foot Ankle Surg 24 : 271, 2018.
-
23.
Song JH , Kang C & Hwang DS et al.: Dorsal suspension for Morton's neuroma: a comparison with neurectomy. Foot Ankle Surg 25 : 748, 2019.
-
24.
Ratanshi I , Hayakawa TE & Giuffre JL: Excision with interpositional nerve grafting: an alternative technique for the treatment of Morton neuroma. Ann Plast Surg 76 : 428, 2016.
-
25.
Barrett SL & Pignetti TT: Endoscopic decompression for intermetatarsal nerve entrapment: the EDIN technique: preliminary study with cadaveric specimens; early clinical results. J Foot Ankle Surg 33 : 503, 1994.
-
26.
Barrett SL & Walsh AS: Endoscopic decompression of intermetatarsal nerve entrapment: a retrospective study. JAPMA 96 : 19, 2006.
-
27.
Kubota M , Ohno R & Ishijima M et al.: Minimally invasive endoscopic decompression of the intermetatarsal nerve for Morton's neuroma. J Orthop 12 (suppl 1) : S101, 2015.
-
28.
Park EH , Kim YS & Lee HJ et al.: Metatarsal shortening osteotomy for decompression of Morton's neuroma. Foot Ankle Int 34 : 1654, 2013.
-
29.
Dellon AL: Treatment of Morton's neuroma as a nerve compression: the role for neurolysis. JAPMA 82 : 399, 1992.
-
30.
Villas C , Florez B & Alfonso M: Neurectomy versus neurolysis for Morton's neuroma. Foot Ankle Int 29 : 578, 2008.
-
31.
Gauthier G: Thomas Morton's disease: a nerve entrapment syndrome: a new surgical technique. Clin Orthop Relat Res (142) : 90, 1979.
-
32.
Weinfeld SB & Myerson MS: Interdigital neuritis: diagnosis and treatment. J Am Acad Orthop Surg 4 : 328, 1996.
-
33.
Villanueva M , Iborra A & Rodriguez G et al.: Ultrasound-guided gastrocnemius recession: a new ultra-minimally invasive surgical technique. BMC Musculoskelet Disord 17 : 409, 2016.
-
34.
Iborra A , Villanueva-Martinez M & Barrett SL et al.: Ultrasound-guided release of the tibial nerve and its distal branches: a cadaveric study. J Ultrasound Med 38 : 2067, 2019.
-
35.
Iborra A , Villanueva MJ & Barrett SL: Ultrasound-guided plantar fascia release with needle: a novel surgical technique. Open J Orthop 6 : 159, 2016.
-
36.
Villanueva M , Iborra Á & Rodríguez G et al.: Ultrasound-guided gastrocnemius recession: a new ultra–minimally invasive surgical technique. BMC Musculoskelet Disord 17 : 409, 2016.
-
37.
Graham CE & Graham DM: Morton's neuroma: a microscopic evaluation. Foot Ankle 5 : 150, 1984.
-
38.
Wolfort SF & Dellon AL: Treatment of recurrent neuroma of the interdigital nerve by implantation of the proximal nerve into muscle in the arch of the foot. J Foot Ankle Surg 40 : 404, 2001.
-
39.
Johnson JE , Johnson KA & Unni KK: Persistent pain after excision of an interdigital neuroma: results of reoperation. J Bone Joint Surg Am 70 : 651, 1988.
-
40.
Lui TH: Endoscopic intermetatarsal ligament decompression. Arthrosc Tech 4 : e807, 2015.
Ultrasound-Guided Decompression of the Intermetatarsal Nerve for Morton's Neuroma: A Novel Closed Surgical Technique
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.
