Longitudinal plantar approaches are generally considered at risk for wound healing problems. Thus, we wanted to investigate long-term outcomes after a primary Morton's neuroma excision through a longitudinal plantar approach. A retrospective study of patients with primary neuroma excision was conducted. Twenty-four patients (28 feet) were evaluated at a mean 9-year follow-up (range, 6-14) by a single trained examiner using a specific postoperative evaluation protocol, including AOFAS Forefoot subjective and objective scores. Good-to-excellent outcomes were reported in 25 (89.3%) cases. A hypertrophic scar formation and keratosis occurred in only 2 cases (7.1%). All the patients, with a single exception, achieved full weightbearing with a postoperative shoe from the first day after the operation. A longitudinal plantar approach can lead to long-term, good-to-excellent outcomes with no case of recurrence or reoperation. Accurate wound closure and immediate weightbearing with a postoperative shoe can minimize the rate of complications. This approach should be considered for primary resection of Morton's neuromas.
Level of Clinical Evidence
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- An anatomical study of Morton's interdigital neuroma: the relationship between the occurring site and the deep transverse metatarsal ligament (DTML).Foot Ankle Int. 2007; 28: 1007-1010
- Su d'un nervoso gangliare rigonfiamento alla pianta del piede. Lettera anatomica al Dr. Salomone Lampronti.Tip. Bracali, Pistoia1835
- Treatise on Corns, Bunions, the Diseases of Nails and the General Management of the Feet.Simpkin-Marshall, London1845
- A peculiar and painful affection of the fourth metatarso-phalangeal articulation.Am J Med Sci. 1876; 71: 37-45
- A study of the communicating branch between the medial and lateral plantar nerves.Foot Ankle. 1984; 4: 313-315
- Plantar versus dorsal incision in the treatment of primary intermetatarsal Morton's neuroma.Foot Ankle Int. 2008; 29: 136-141
- A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton's neuroma.Foot Ankle Int. 2013; 34: 1198-1204
- The outcome after using two different approaches for excision of Morton's neuroma.Chin Med J (Engl). 2010; 123 (PubMed PMID: 20819664): 2195-2198
- Neurectomy outcomes in patients with Morton neuroma: comparison of plantar vs dorsal approaches.Ochsner J. 2016; 16 (PubMed PMID: 27999504): 471-474
- Excision of Morton's neuroma using a longitudinal plantar approach: a midterm follow-up study.Foot Ankle Spec. 2016; 9: 37-42
- Validation of the American College of Foot and Ankle Surgeons scoring scales.J Foot Ankle Surg. 2011; 50: 420-429
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.J Foot Ankle Surg. 2007; 46: 65-74
- Diagnostic accuracy of clinical tests for Morton's neuroma compared with ultrasonography.J Foot Ankle Surg. 2015; 54 (PMID: 25432459): 549-553
- Morton's interdigital neuroma: a comprehensive treatment protocol.Foot Ankle Int. 1995; 16: 760-763
- Operative treatment of interdigital neuroma: a long-term follow-up study.J Bone Joint Surg Am. 2001; 83 (PMID: 11568193): 1321-1328
- Interdigital neuroma: clinical examination and histopathologic results in 63 cases treated with excision.Foot Ankle Int. 2004; 25: 79-84
- Long-term evaluation of interdigital neuroma treated by surgical excision.Foot Ankle Int. 2008; 29: 574-577
- Interventions for the treatment of Morton's neuroma.Cochrane Database Syst Rev. 2004; (Review. PMID: 15266472)CD003118
- Surgery of Morton's neuroma: dorsal or plantar approach?.J R Coll Surg Edinb. 1997; 42 (PMID: 9046143): 36-37
- Long-term results of neurectomy through a dorsal approach in the treatment of Morton's neuroma.Adv Clin Exp Med. 2016; 25: 295-302
- Clinical results of simultaneous adjacent interdigital neurectomy in the foot.Foot Ankle Int. 1996; 17: 264-268
- Plantar approach for excision of a Morton neuroma: a long-term follow-up study.J Bone Joint Surg Am. 2012; 94: 654-658
- Surgical treatment of Morton's neuroma: clinical results after open excision.Int Orthop. 2013; 37: 1857-1861
- Morton's interdigital neuroma of the foot: a literature review.Foot Ankle Surg. 2018; 24: 92-98
Published online: October 22, 2021
Financial Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interest: None reported.
© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.