REVIEWS OF DR. SCHULER
NEW JOURNAL ARTICLES REVIEWS SURGERY FOR MORTON’S NEUROMA
Authored by Dr. Burton S. Schuler,
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It has been an open secret for years that the surgery for the excision of a Morton neuroma left a great deal to be desired
Recently there have been several articles in Medical Journals that support this position concerning the problems with this surgery.
In Long-term results of neurectomy in the treatment of Morton’s neuroma: more than 10 years’ follow-up. Kyung Tai Lee, M.D., and others, Foot Ankle Spec. 2011 Dec;4(6):349-53. doi: 10.1177/1938640011428510. Epub 2011 Dec 1
the authors stated that they reviewed 7 different studies between 1991-2008 and their results regarding the surgery were slightly worst than other published reports done regarding the Morton’s neuroma surgery. They went on to say complications of the surgery included numbness and long lasting pain. And, this pain could cause footwear restriction and a poor results of the surgery in general.
They also stated regarding numbness
“There was a great deal of numbness reported by patients, thus we assumed that continued numbness postoperatively may have affected the results, and could be one of several considerations, in terms of post op results.“
Finally Lee and his group warned the doctors reading this article to ‘be aware of the long term prognosis” in regard to cutting out the Morton’s Neuroma and to make sure you tell your patient’s up front about the possible long term effects from this surgery. The doctor better cover himself and tell the patient from the outset that most probably they will have some numbness at the area of surgery, permanently, and may have some problems wearing shoes permanently.
In another study regarding Morton’s Neuroma Surgery entitled
Long-term Evaluation of Interdigital Neuroma treated by Surgical Excision. Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Foot Ankle Int. 2008 Jun;29(6):574-7. doi: 10.3113/FAI.2008.0574.
The authors stated that only 51% of the patients felt they had a good outcome in regard to cutting out of their Morton’s Neuroma while 40% had poor results.
In another article regard excision of Morton’s Neuroma entitled :
The Outcome of Morton’s Neurectomy in the Treatment of Metatarsalgia Int Orthop. 2010 April; 34(4): 511–515. Published online 2009 May 30. doi: 10.1007/s00264-009-0812-3
The 78 patients in the study felt that after an average of 4 ½ years, over ¾ of them still complained of numbness in their toes. While 85% still complained of some pain going up to to the forefoot. About ½ stated that this pain was relieved by rubbing the foot. But about ½ said they were completely satisfied with the procedure. The authors did admit that many patients did have some on ongoing discomfort in the area of the surgery; and 7 out of 10 still have some problems wearing shoes. The study also commented that n numbness in the web space postoperativly was very common.
From the above it is clear that the classical Morton’s Neuroma Excision Surgery does have many intrinsic problems The good news there are other surgery available for the treatment of painful Morton’s Neuroma, that is in fact much less traumatic to the patient, with a much shorter healing time, with much less pain and can be done in the doctors office. These 3 well established surgeries have been around for many years and have been time tested These surgeries are so well established that the U.S. Government in their Agency for Healthcare Research and Quality, has included the three surgeries below as part of The National Guideline Clearinghouse as a acceptable treatment for Morton’s Neuroma. These guidelines were developed with the help of Academy of Ambulatory Foot and Ankle Surgery.
- Osteotomy of adjacent metatarsal(s) may be used for intermetatarsal neuroma in the event that the metatarsal is malpositioned or malformed, and that the purpose of the osteotomy is for treatment of both the neuroma and the pathological metatarsal as well.
- Tendon lengthening/tenotomy/capsulotomy may be used for intermetatarsal neuroma in the event that the purposeof these procedures is both for treatment of the neuroma and the soft tissue pathology.
- Severing of the inter metatarsal ligament.
All three of the above are proved alternatives to the standard surgical removal of the Morton’s Neuroma. As of this writing most neuromas are still being cut out, with all of the side effects (ie numbness, pain) associated with it. Swelling of the feet from the above is also associated with this
Please see my 12 minute video on neuroma if you would like to learn more about this painful problem