Metatarsal shortening osteotomy for decompression of Morton's neuroma

Abstract

Background: Among the various operative treatments of Morton's neuroma, deep transverse metatarsal ligament (DTML) release has been performed for decompression of neuroma. However, the main lesion of Morton's neuroma is located between the metatarsal head and the metatarsophalangeal (MTP) joint and more distal than the DTML. Hence we performed the metatarsal shortening osteotomy along with DTML release for decompression of neuroma, and investigated the clinical outcomes of it and compared the outcomes with those of DTML release alone.

Methods: We retrospectively reviewed 84 consecutive patients (86 neuromas) who underwent surgery for a Morton's neuroma between February 2008 and March 2011. The first 46 neuroma (group A) were treated with DTML release alone, and the next 40 neuroma (group B) underwent the metatarsal shortening osteotomy with DTML release. Clinical outcomes were compared between the groups and the associations between clinical outcomes and neuroma size were assessed.

Results: Clinical outcomes were significantly improved after surgery in both groups but there were significant differences in clinical outcomes between the 2 groups at final follow-up. There were significant correlations between neuroma size and outcomes in group A, whereas no significant correlations were found between neuroma size and outcomes in group B.

Conclusion: The metatarsal shortening osteotomy with DTML release resulted in better outcomes compared with DTML release alone in patients with Morton's neuromas.

Level of evidence: Level III, retrospective comparative series.

Keywords: Morton’s neuroma; decompression; metatarsal shortening osteotomy.