OBJECTIVE: To determine the outcome of surgical excision of Morton's n
euroma after a local anesthetic diagnostic block into the neuroma has
relieved symptoms. DESIGN: A cohort study. SETTING: A university affil
iated hospital. PATIENTS: A Sequential series of 37 patients who under
went 41 excisions with at least 2 years' follow-up. Seven patients had
undergone repeat excision of a neuroma, and 34 primary excisions were
performed. Surgery was performed by a specialist in orthopedic surger
y of the foot and ankle. INTERVENTION: Excision of the Morton's neurom
a after a positive diagnostic block. MAIN OUTCOME MEASURES: Grade of s
ymptoms at follow-up done by independent review on a 4-point scale. RE
SULTS: Of 41 procedures, 11 had an unfavourable outcome: 4 procedures
were graded 3, and 7 procedures were graded 4. Eight (24%) of the 34 p
rimary procedures were reported as failures, and 3 (43%) of the 7 revi
sion procedures were reported as failures. Most patients reported poor
results owing to persistent pain. CONCLUSIONS: Diagnostic blocks do n
ot improve the results of surgery for excision of Morton's neuroma and
are not recommended. Because failure rates are greater than 20%, surg
ery for Morton's neuroma should only be offered after a full course of
nonoperative management.