TREATMENT OF MORTONS-NEUROMA BY NEURECTOM Y - A REVIEW OF 43 CASES

Purpose of the study Morton's neuroma is a frequent cause of metatarsa lgia. its diagnosis is clinical but progress in medical imaging : ultr asound, evoked potentials and above all MRI allows an improvement of p ara-clinical diagnosis. Material and methods 48 neuromas were treated surgically between 1979 and 1990. That represents 46 feet in 43 patien ts. Female predominance was clear with an average age ot 53 years. The follow-up period was 6 years and 10 months. 3 patients had multiple i njuries. Medical treatment had been prescribed prior to surgery in 24 patients (15 had injections, 9 orthopedic shoe inserts and 5 both inje ctions and inserts). The interval between the first symptoms and surge ry was long since it was on average of 3 years and 6 months. The neuro ma was located 36 times in the third interdigital space. The initial i ncision was plantar 11 times dorsal 32 times. Only neurectomies were p erformed. The neuroma was very large 9 times. 10 patients had treatmen t for other affections in the same operative time. Results At review, 41 feet were completely painless. Shoe wear was normal for 32 patients . 12 pulpar hypoesthesia and 7 commissural and pulpary hypoesthesia we re noted. 3 of 11 patients operated by the plantar approach had a pain ful hyperkeratosic scar. Discussion None of our cases had preoperative MRI because our most recent case has 4 years of evaluation. At the pr esent time the MRI could contribute to diagnosis owing to good tissula r differentiation. The neurectomy led to a total disappearance of pain but hypoesthesia was frequent. The dorsal approach induces cutaneous complication. Neurolysis induces a sensitive postoperative deficit but recurrence occurs in 77 per cent of cases after neurolysis. Conclusio n Morton's neuroma is located essentially in the third interdigital sp ace. Neurectomy is a simple operation that often leads to recovery.