Intak Chu; Hoseong Jang; Hyun-Woo Park

doi:10.14193/jkfas.2015.19.2.58

Journal List > J Korean Foot Ankle Soc > v.19(2) > 1043372

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Chu, Jang, and Park: Corrective Osteotomy of Metatarsal Bone for Surgical Treatment of Morton’s Neuroma

Original Article

J Korean Foot Ankle Soc 2015;19(2):58-62.

Published online: 19 June 2015

DOI: https://doi.org/10.14193/jkfas.2015.19.2.58

Corrective Osteotomy of Metatarsal Bone for Surgical Treatment of Morton’s Neuroma

Intak Chu^*, Hoseong Jang, Hyun-Woo Park

Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Busan, Korea

^*Korea Orthopedics Clinic for Special Surgery, Busan, Korea

Corresponding Author: Hyun-Woo Park Department of Orthopedic Surgery, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan 330-714, Korea Tel: 82-41-550-3296, Fax: 82-41-556-3238, E-mail: m3artist@hanmail.net

Received 12 April 201527 April 2015 Accepted 10 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The purpose of this report is to investigate the clinical and radiological results of corrective osteotomy of the 3rd metatarsal bone for shortening and dorsal displacement without exposure around neuroma.

Materials and Methods:

Twelve cases of patients who underwent corrective osteotomy of metatarsal bone for a Morton’s neuroma from November 2013 to September 2014 were retrospectively reviewed. Corrective osteotomy was performed through a dorsal approach at the 3rd metatarsal bone base and distal metatarsal bone was displaced dorsally and proximally. Preoperative and postoperative pain assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and radiographs were evaluated.

Results:

The mean age of patients was 41.4 years, and the mean follow-up period was 10.7 months. AOFAS score improved from 52 preoperatively to 90 postoperatively. The 3rd metatarsal bone was shortened by an average of 3.39 mm and elevated by 2.38 mm.

Conclusion:

Corrective osteotomy of metatarsal bone can be regarded as a new surgical option for Morton’s neuroma without exposure around neuroma.

Keywords: Metatarsal bones, Osteotomy, American Orthopaedic Foot and Ankle Society score, Neuroma, Metatarsalgia

REFERENCES

1.Gauthier G. Thomas Morton’s disease: a nerve entrapment syndrome. A new surgical technique. Clin Orthop Relat Res. 1979. 142:90–2.

2.Rasmussen MR., Kitaoka HB., Patzer GL. Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clin Orthop Relat Res. 1996. 326:188–93.

3.Kay D., Bennett GL. Morton’s neuroma. Foot Ankle Clin. 2003. 8:49–59.

4.Bennett GL., Graham CE., Mauldin DM. Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int. 1995. 16:760–3.

5.Shapiro SL. Endoscopic decompression of the intermetatarsal nerve for Morton’s neuroma. Foot Ankle Clin. 2004. 9:297–304.

6.Kasparek M., Schneider W. Surgical treatment of Morton’s neuroma: clinical results after open excision. Int Orthop. 2013. 37:1857–61.

7.Fabié F., Accadbled F., Tricoire JL., Puget J. Anatomic danger of percutaneous section of the inter-metatarsal ligament for the treatment of Morton’s neuroma. Rev Chir Orthop Reparatrice Appar Mot. 2007. 93:720–4.

8.Zelent ME., Kane RM., Neese DJ., Lockner WB. Minimally invasive Morton’s intermetatarsal neuroma decompression. Foot Ankle Int. 2007. 28:263–5.

9.Stamatis ED., Karabalis C. Interdigital neuromas: current state of the art--surgical. Foot Ankle Clin. 2004. 9:287–96.

10.Maestro M., Besse JL., Ragusa M., Berthonnaud E. Forefoot mor-photype study and planning method for forefoot osteotomy. Foot Ankle Clin. 2003. 8:695–710.

11.Mulder JD. The causative mechanism in morton’s metatarsalgia. J Bone Joint Surg Br. 1951. 33-B:94–5.

12.Mendicino SS., Rockett MS. Morton’s neuroma. Update on diagnosis and imaging. Clin Podiatr Med Surg. 1997. 14:303–11.

13.Sharp RJ., Wade CM., Hennessy MS., Saxby TS. The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg Br. 2003. 85:999–1005.

14.Coughlin MJ., Pinsonneault T. Operative treatment of interdigital neuroma. A long-term follow-up study. J Bone Joint Surg Am. 2001. 83:1321–8.

15.Johnson JE., Johnson KA., Unni KK. Persistent pain after excision of an interdigital neuroma. Results of reoperation. J Bone Joint Surg Am. 1988. 70:651–7.

16.Akermark C., Saartok T., Zuber Z. A prospective 2-year followup study of plantar incisions in the treatment of primary intermetatarsal neuromas (Morton’s neuroma). Foot Ankle Surg. 2008. 14:67–73.

17.Kim JY., Choi JH., Park J., Wang J., Lee I. 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. 28:1007–10.

18.Hofstaetter SG., Hofstaetter JG., Petroutsas JA., Gruber F., Ritschl P., Trnka HJ. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg Br. 2005. 87:1507–11.

19.Khurana A., Kadamabande S., James S., Tanaka H., Hariharan K. Weil osteotomy: assessment of medium term results and predictive factors in recurrent metatarsalgia. Foot Ankle Surg. 2011. 17:150–7.

20.Bauer T., Gaumetou E., Klouche S., Hardy P., Maffulli N. Metatarsalgia and Morton’s disease: comparison of outcomes between open procedure and neurectomy versus percutaneous metatarsal osteotomies and ligament release with a minimum of 2 years of follow-up. J Foot Ankle Surg. 2015. 54:373–7.

21.Myerson MS. The diagnosis and treatment of injury to the tarsometatarsal joint complex. J Bone Joint Surg Br. 1999. 81:756–63.

Figure 1.

Widened web space by metatarsal pad.

Figure 2.

Method for the measurement of 3rd metatarsal length. Third metatarsal length (dashed line) was determined by measuring the distances from apex of each metatarsal to transmetatarsal line centered from lateral sesamoid and perpendicular to the second metatarsal axis.

Figure 3.

Metatarsal osteotomy from proximal dorsum to distal base obliquely.

Figure 4.

Metatarsal osteotomy was stabilized using a screw and proximal dorsal edge was cut off.

Figure 5.

C-arm radiographs. (A) Preoperative sesamoid view. (B) Postoperative sesamoid view (arrow). Third metatarsal bone was dorsally displaced after the metatarsal corrective osteotomy.

Figure 6.

(A) Preoperative foot standing anteroposterior (AP) radiograph. (B) Postoperative foot standing AP radiograph. After the metatarsal corrective osteotomy, the length of 3rd metatarsal bone was shortened.

Table 1.

Summary of Cases

No.	Age (yr)/sex	Location (web space)	Third metatarsal dorsal displacement (mm)	Third metatarsal length (mm)		AOFAS score		Foot function index
No.	Age (yr)/sex	Location (web space)	Third metatarsal dorsal displacement (mm)	Preop	Postop	Preop	Postop	Preop	Postop
1	37/M	2nd, 3rd	1.99	7.16	2.92	52	90	50	12
2	58/F	2nd, 3rd	2.23	13.65	10.69	52	90	130	35
3	52/F	2nd, 3rd	2.67	12.36	10.57	59	90	86	2
4	48/M	2nd	2.50	11.81	8.38	48	90	149	41
5	25/M	3rd	2.58	8.38	5.74	44	80	166	77
6	47/M	2nd, 3rd	2.38	11.94	9.18	50	87	159	46
7	47/M	2nd, 3rd	2.53	13.33	8.88	50	87	159	46
8	39/M	2nd, 3rd	1.90	15.20	11.54	44	90	168	45
9	37/F	2nd	2.62	10.20	5.64	62	100	144	18
10	36/M	2nd, 3rd	2.72	17.03	13.57	62	100	140	39
11	37/F	2nd, 3rd	2.35	7.65	4.31	52	82	51	25
12	39/M	2nd, 3rd	2.16	11.33	7.99	50	90	105	49

M: male, F: female, AOFAS: American Orthopaedic Foot and Ankle Society, Preop: preoperative, Postop: postoperative.

Table 2.

Functional and Radiologic Results

Evaluated data	Preoperative	Postoperative	Difference	p-value
AOFAS score	52.08±6.07	89.67±5.88	37.58±4.27	0.005
Third metatarsal length (mm)	11.67±2.99	8.28±3.15	3.39±0.80	0.000
Third metatarsal dorsal displacement (mm)	0	2.38±0.27	2.38±0.27	0.000
Foot function index	125.58±42.69	36.25±19.87	89.33±32.89	0.017

Values are presented as mean±standard deviation. AOFAS: American Orthopaedic Foot and Ankle Society.

TOOLS

Similar articles