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Lee W, McDonald J, Azam M, Lachance AD. The comparison of postoperative outcomes in Morton's neuroma excision between plantar versus dorsal approach: A systematic review and meta-analysis. Foot Ankle Surg 2024:S1268-7731(24)00122-X. [PMID: 38880729 DOI: 10.1016/j.fas.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/27/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Current literature lacks comprehensive information comparing the clinical outcomes of plantar and dorsal approaches for Civinini-Morton syndrome, also known as Morton's neuroma. This systematic review and meta-analysis was conducted to evaluate and compare the clinical outcomes of neurectomy for Morton's neuroma, focusing on the differences between the plantar and dorsal approach. METHODS Our comprehensive literature review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and utilized databases including PubMed, Embase, Web of Science, and the Cochrane Library. Data investigated in this study included postoperative sensory loss, scar tenderness, reoperation, histopathology, complications, pain score, patient satisfaction, functional scores, and time to weight bearing. RESULTS Total eight studies were included in this study. In aggregate, 237 neuromas underwent excision using the plantar approach, while 312 neuromas were treated via the dorsal approach. A significantly higher rate of postoperative reduced sensory was found in the dorsal group: 48.5 % (64/132) Vs. 62.0 % (80/129) with the relative ratio (RR) of 0.79 (95 % CI, 0.64-0.97). A significantly higher rate of postoperative scar tenderness was noted in the plantar group: 16.7 % (32/192) Vs. 6.2 % (14/225) with the RR of 2.27 (95 % CI, 1.28-4.04). Regarding the histopathology, 99.3 % (143/144) and 97.1 % (134/138) accuracy rate was confirmed in the plantar approach and dorsal approach, respectively, with the RR of 1.02 (95 % CI, 0.98-1.07). Overall reoperations and complications were not different between groups at 5.3 % (10/189) and 8.8 % (19/216) in the plantar group versus 6.1 % and 12.0 % (35/291) in dorsal group. CONCLUSIONS We recommend detailed discussions with patients prior to surgery to weigh the advantages and disadvantages of each approach.
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Affiliation(s)
- Wonyong Lee
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre 18840, PA, USA.
| | - John McDonald
- Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton 18510, PA, USA.
| | - Mohammad Azam
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre 18840, PA, USA.
| | - Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre 18840, PA, USA.
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Giarda F, Agostini A, Colonna S, Sciumè L, Meroni A, Beretta G, Dalla Costa D. Infiltrative Type I Collagen in the Treatment of Morton's Neuroma: A Mini-Series. J Clin Med 2023; 12:4640. [PMID: 37510755 PMCID: PMC10380245 DOI: 10.3390/jcm12144640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve, most commonly affecting the third inter-digital space. The conservative approach is the first recommended treatment option. However, other different approaches have been proposed, offering several options of treatments, where, several degrees of efficacy and safety have been reported. We treated five consecutive patients affected by MN through three indirect ultrasound-guided injections of type I porcine collagen at weekly intervals. All patients were assessed before the treatment, after the treatment and up to 6 months after the last injection via AOFAS and VNS scores for pain, in which the function and pain were evaluated, respectively. In all patients, both analyzed variables progressively ameliorated, with benefits lasting until the last follow-up. The trend of the scores during the follow-up showed significant statistical differences. No side effects occurred. To our knowledge, this is the first study on injections of type I porcine collagen for the treatment of Morton's neuroma. Future research is needed to confirm the positive trend achieved in this MN mini-series.
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Affiliation(s)
- Federico Giarda
- Unit of Rehabilitation Medicine and Neurorehabilitation, Department of Neuroscience, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Adele Agostini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Stefano Colonna
- Unit of Rehabilitation Medicine and Neurorehabilitation, Department of Neuroscience, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Luciana Sciumè
- Unit of Rehabilitation Medicine and Neurorehabilitation, Department of Neuroscience, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Alberto Meroni
- Department of Orthopedic Surgery and Traumatology, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Giovanna Beretta
- Unit of Rehabilitation Medicine and Neurorehabilitation, Department of Neuroscience, ASST Niguarda Hospital, 20162 Milan, Italy
| | - Davide Dalla Costa
- Unit of Rehabilitation Medicine and Neurorehabilitation, Department of Neuroscience, ASST Niguarda Hospital, 20162 Milan, Italy
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Ortu S, Fiori E, Bagnoli I, Valente A, Pisanu F, Caggiari G, Doria C, Milano L. Complications of alcohol injections for Morton’s neuroma. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221116392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Morton’s neuroma (MN) is a neuropathic metatarsalgia that causes pain in the plantar aspect of the forefoot generally between the third and fourth metatarsal heads. Treatment can be nonoperative or surgical. Among nonoperative procedures, alcohol injections are still commonly used as considered simple, relatively safe and well-tolerated treatment. However, they present transient and minor complications. Methods Two hundred patients with a diagnosis of MN underwent ultrasound-guided injections with a 47.5% alcohol solution between 2013 and 2020. We reviewed the current literature to highlight the known complications of this treatment, comparing them to the complications developed by our patients. Results Three patients out of 200 patients, developed necrosis of skin and subcutaneous tissue not described in previous studies about MN. Conclusions Our study focuses attention on the complications subsequent to the alcohol injection therapy for MN. Patients and surgeons should be aware that in a small number of cases this therapy can be burdened by necrotic complications of the skin.
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Affiliation(s)
| | - Enrico Fiori
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Ignazio Bagnoli
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
| | - Angiola Valente
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
| | - Francesco Pisanu
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Gianfilippo Caggiari
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Carlo Doria
- Orthopaedic and Traumatology Department, Sassari University Hospital, Sassari, Italy
| | - Luigi Milano
- Orthopaedic Department – Foot Surgery, Humanitas Cellini, Torino, Italy
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Arshad Z, Alshahwani A, Bhatia M. The Management of Multiple Morton's Neuromas in the Same Foot: A Systematic Review. J Foot Ankle Surg 2022; 61:163-169. [PMID: 34526223 DOI: 10.1053/j.jfas.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/11/2021] [Accepted: 08/05/2021] [Indexed: 02/03/2023]
Abstract
The optimal treatment strategy for the presentation of multiple Morton's neuromas in adjacent intermetatarsal spaces of the same foot is yet to be determined. We aimed to summarize and assess the efficacy of current treatment strategies. A systematic review, adhering to PRIMSA guidelines was performed. A computer base search was completed in PubMed, Embase, Cinahl, ISI Web of Science, Scopus and Emcare, for articles reporting the treatment of multiple neuromas in the same foot. The review is registered in the international prospective register of systematic reviews (CRD42020213631). A total of 253 articles were identified, with 7 articles being included in the review. The most common treatment strategy reported was simultaneous neuroma excision using a single incision, while 2 studies each describe simultaneous excision with 2 separate incisions and delayed excision respectively. There is no strong evidence favoring use of delayed excision or multiple incisions. Further high-quality research is required to make more definitive conclusions and future research should investigate other strategies such as non-operative treatment.
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Affiliation(s)
- Zaki Arshad
- Medical Student, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
| | - Awf Alshahwani
- Trauma and Orthopaedics Registrar (Resident), Department of Trauma and Orthopaedic Surgery, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | - Maneesh Bhatia
- Consultant (Attending) in Trauma and Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
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Colò G, Rava A, Samaila EM, Palazzolo A, Talesa G, Schiraldi M, Magnan B, Ferracini R, Felli L. The effectiveness of shoe modifications and orthotics in the conservative treatment of Civinini-Morton syndrome: state of art. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:60-68. [PMID: 32555077 PMCID: PMC7944831 DOI: 10.23750/abm.v91i4-s.9713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 01/01/2023]
Abstract
Civinini Morton’s Syndrome (CMS), better known as Morton’s Neuroma, is a benign enlargement that typically affects the third common digital branch of the plantar nerve. It is a common cause of metatarsalgia leading to debilitating pain. It prefers the female gender, with a female to male ratio of 5:1 and an average age of 50 years at time of surgery. Precise aetiology remains under debate, with four etiopathogenetic theories often cited in the literature. Clinical symptoms, physical exam and instrumental evidence are important in assessing and grading the disease. Biomechanics seem to play an important role, especially regarding the usefulness of correct footwear. The first approach in the early stages of this condition usually begins with shoe modifications and orthotics, designed to limit the nerve compression. In order to prevent or delay the development of CMS, shoes should be sufficiently long, comfortable, broad toe-boxed, should bear a flat heel and a sufficiently thick external sole which should not be excessively flexible. Most authors suggested that an insole with medial arch support and a retrocapital bar or pad, just proximal to the metatarsal heads, displaces the pressure sites and can be beneficial to relieve the pain from the pinched nerve. A threshold period of 4.5 months appears to emerge from the results of the analysed studies, indicating that, beyond this period and in neuromas larger than 5-6 mm, orthotics and/or shoes modifications do not seem to give convincing results, proving to be more a palliation for the clinical condition to allow an acceptable life with pain rather than a real treatment. (www.actabiomedica.it)
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Affiliation(s)
- Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy..
| | - Alessandro Rava
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10121, Turin, Italy.
| | - Elena Manuela Samaila
- Department of Orthopedics and Trauma Surgery, University of Verona, Surgical Center "P. Confortini", P.le A. Stefani 1, 37126, Verona (VR), Italy.
| | - Anna Palazzolo
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10121, Turin, Italy.
| | - Giuseppe Talesa
- Orthopaedic and Traumatologic Clinic, University of Perugia, Santa Maria della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy.
| | - Marco Schiraldi
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
| | - Bruno Magnan
- Department of Orthopaedic and Truama Surgery, University of Verona, Italy.
| | - Riccardo Ferracini
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy.
| | - Lamberto Felli
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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