Isolated Intermetatarsal Ligament Release as Primary Operative Management for Morton’s Neuroma: Short-term Results

Abstract

Background Although the precise pathoetiology of Morton’s neuroma remains unclear, chronic nerve entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional operative management entails neuroma excision but risks unpredictable formation of stump neuroma. Materials and methods Medical records were examined for adult patients who failed at least 3 months of conservative treatment for symptomatic and recalcitrant Morton’s neuroma and who then underwent isolated IML decompression without neuroma resection. Results A total of 12 patients underwent isolated IML decompression for Morton’s neuroma with an average follow-up of 13.5 months. Visual Analog Pain Scale averaged 6.4 ± 1.8 (4-9) preoperatively and decreased to an average of 2 ± 2.1 (0-7) at final follow-up (P = .002). All patients reported significant improvement. Conclusion Isolated IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief, with no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. Level of Evidence: Level IV: Case series

Study of the Anatomical Association between Morton’s Neuroma and the Space Inferior to the Deep Transverse Metatarsal Ligament Using Ultrasound

“…Though this attempt to create more space for the MN by cutting the DTML is a very common technique, no publication has been found that measures this space and that connects it with MN. For this reason, our results may be reinforced amidst the great variety of surgical techniques which aim at freeing the DTML to create more space for the MN [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

Fascial Manipulation Technique in the Conservative Management of Morton’s Syndrome: A Pilot Study

“…It is important to note that other authors also considered a treatment strategy based on the release of the CDPN. Recently, Elghazy et al [18] proposed a surgical technique for the open release of intermetatarsal ligaments (IML), resulting in nerve decompression by alleviating both IML incarceration and metatarsal head compression via expansion of the available intermetatarsal space in both the transverse and sagittal planes. In their retrospective, 12-case series studies, these authors reported equal or better clinical outcomes at short-term follow-up than those reported for nerve excision, considering that the complications reported after nerve removal do not appear to exist with simple IML decompression.…”

“…Diagnosis is confirmed by ultrasound examination or MRI, even if they demonstrate high false negative values and appear to be relevant only when the size of the neuroma exceeds 5 mm in transverse diameter [15,16]. Although its primary aetiopathogenesis is not fully known and remains controversial [17], the most common hypothesis considers MS as a canalicular syndrome [18] due to the particular conformation and functional complexity of the distal intermetatarsal region, which is a stiff osteofibrous channel. Other theories have hypothesized that the intermetatarsophalangeal bursa could play a significant role, whereas others have postulated alternative vascular or traumatic insults as a cause of the disease.…”

“…First-line management is nonoperative [1]. The most reliable treatments include lifestyle modifications, such as avoidance of tight fitting shoes, orthotics, local infiltrations of corticosteroids [18,[23][24][25], as well as mobilisation and manipulation techniques [26][27][28][29]. Surgical intervention, recommended after failure of conservative therapies, includes neurectomy, i.e., excision of the affected CDPN segment, and neurolysis.…”

Tratamiento mediante descompresión del neuroma de Morton: visión actual y recomendaciones

“…En 2020, Elghazy y cols. 23 mostraron sus resultados en una serie pequeña de 12 pacientes) con descompresión del neuroma y recolocación dorsal del nervio/neuroma con un seguimiento medio de 13.5 meses. Ellos reflejaron mejoría significativa en todos sus casos con una disminución de la escala analógica visual del dolor de 6.4 en el preoperatorio a 2.0 en el postoperatorio.…”