A service review of the patient focused outcomes of neuroma excision at a mean follow-up of 8 years and 10 months

Abstract

Background - While the majority of patients do well following neuroma excision, good outcomes are far from universal. Hence we always provide a course of non-surgical treatment prior to surgery – footwear advice, orthotics, patient education and up to 3 corticosteroid injections. Furthermore, we wanted to understand and quantify the risks and complication to allow us to be able to provide this information to patients during informed consent.Methods - Between 2000 and 2012 neuroma excision from the 2nd intermetatarsal or 3rd intermetatarsal space was carried out consecutively on 42 cases (36 patients), for the treatment of IM neuroma pain. Three patients from the cohort died prior to follow-up and 6 cases failed to attend for review. The outcomes of surgery were measured in a service review using a visual analogue pain scale, the Manchester Oxford Foot Questionnaire, clinical examination of the foot and consultation with the patient where any adverse issues were recorded. The mean follow-up period was 8-years and 10-months (range 61-194 months). At the time of surgery, the mean age of the patients was 54-years of age (range 25-74 years) and at follow-up the mean age was 63-years of age (range 31-85 years).Results - Twenty four cases (73%) reported they were completely satisfied with the results of their surgery, 8 cases (24%) were satisfied with reservations and 1 case (3%) reported they were dissatisfied. All cases agreed they would be happy to undergo surgery under similar circumstance again if required, i.e. under local anaesthesia on a day case basis. 2 cases (6%) reported recurrence of symptoms and required revision surgery which was performed in one case at 9-years and in the other at 11-years. After further excision of nerve tissue, their symptoms resolved.Conclusion - Neuroma excision is a reasonably safe and effective treatment for neuroma pain when non-surgical treatments fail to resolve symptoms. Our approach requires meticulous clinical examination and history taking, up to three cortisone injections and then ultrasound examination before the patient is listed for surgery. In this way we hope to minimise the risk of incorrect diagnosis and continued pain post excision due to the presence of undiagnosed capsulitis.