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. 2020 Jun 30;14(3):200-204.
doi: 10.1055/s-0040-1713081. eCollection 2022 Jul.

Microsurgical Neurectomy for Morton’s Neuroma

[Article in German]
Keiichi Muramatsu  1   2 , Yasuhiro Tani  1 , Tetsuya Seto  1 , Jasson Arcinue  1 , Ryuta Iwanaga  2 , Takashi Sakai  2
Affiliations

Microsurgical Neurectomy for Morton’s Neuroma

[Article in German]
Keiichi Muramatsu et al. J Hand Microsurg. .

Abstract

Introduction “Morton’s neuroma” is one of the common causes of forefoot pain. If conservative therapy fails, surgical treatment should be performed. Microscopy is often used to operate on the digital nerve in the hand. However, to our knowledge, there has only been one report on the use of microsurgical technique. In this study, we describe a new microsurgical technique for Morton’s neuroma and discuss the advantages of this procedure.

Materials and Methods Ten patients with Morton’s neuroma underwent surgical neurolysis or neurectomy using microsurgical technique. All patients were females with a mean age of 53 years (range = 35–65). The average follow-up time after surgery was 18 months (range = 6–24 months).

Results Four cases initially underwent microsurgical neurolysis, but the patient’s symptoms did not improve. Two of these cases were then referred for revision surgery by microsurgical neurectomy. Following neurectomy, the mean preoperative pain and functional score improved significantly. In five cases, histopathology showed the neuroma was surrounded by metatarsal bursitis. In three cases, the nerve was sutured because each stump was easily reached.

Conclusion Microsurgical technique allows careful visualization of the plantar digital nerve even through a dorsal approach. Separation of the digital nerve from the adhesive fibrous tissue can be performed quite readily under the microscope and Morton’s neuroma can then be completely removed en block. In some cases, microsurgical nerve repair may also be possible. A microsurgical approach is a reliable and useful tool for neurectomy of Morton’s neuroma.

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Conflict of interest statement

Conflict of Interest None declared. Ethical Approval This study was approved by the Regional Ethics Committee of Nagato General Hospital. Informed consent was obtained from all patients.

Figures

Fig. 1
Fig. 1
Case 8. A 35-year-old woman with Morton’s neuroma between the second and third metatarsal heads. Magnetic resonance imaging showed Morton’s neuroma as a dumbbell-shaped mass.
Fig. 2
Fig. 2
Under microscopic view, the plantar digital nerve was surrounded by metatarsal interphalangeal bursitis.
Fig. 3
Fig. 3
Following resection of the affected digital nerve together with the bursitis, both ends of the nerve were repaired with microsurgical technique.
Fig. 4
Fig. 4
Histopathology of the resected specimen showed the neuroma was surrounded by metatarsal bursitis.
See this image and copyright information in PMC

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