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Treatment of Morton’s neuroma with minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML): a case series with minimum two-year follow-up
International Orthopaedics ( IF 2.7 ) Pub Date : 2022-08-29 , DOI: 10.1007/s00264-022-05557-0
Gustavo Sato 1, 2 , Gabriel Ferraz Ferreira 2, 3, 4 , Davy Sevilla 5 , Carolinne Nascimento Oliveira 5 , Thomas Lorchan Lewis 6 , Mauro Cesar Mattos E Dinato 1, 2 , Miguel Viana Pereira Filho 2, 3
Affiliation  

Background

The optimal treatment of symptomatic Morton’s neuroma remains unclear; conservative methods are sometimes ineffective and neurectomy has significant rates of patient dissatisfaction. The aim of this study was to evaluate the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML) in patients with Morton’s neuroma.

Methods

Between January 2018 and November 2019, 27 patients (29 feet) diagnosed with Morton’s neuroma after clinical and radiological evaluation underwent DMMO and percutaneous DTML release. The primary clinical outcomes were pain (VAS) and function (AOFAS score). Secondary outcomes included patient satisfaction, complications, and radiographic outcomes. Patients were followed up for a minimum of two years.

Results

The median age of the participants was 66 years (range 48–79) and the follow-up time was 28 months (24–47). There was a decrease of 5.7 points in the VAS for pain (p < .001) and an increase of 19.9 in AOFAS (p < .001) after the surgical procedure. There was one case of superficial infection and one patient required resection of the neuroma (neurectomy). The majority of patients (89.7%) were satisfied and considered the procedure outcome as excellent or good.

Conclusion

Treatment of Morton’s neuroma with minimally invasive distal metatarsal metaphyseal osteotomy and percutaneous release of the deep transverse metatarsal ligament showed significant improvement in pain and function with a low incidence of complications and a high rate of personal satisfaction.



中文翻译:

用微创远端跖骨干骺端截骨术 (DMMO) 和经皮松解跖骨深横韧带 (DTML) 治疗莫顿氏神经瘤:至少随访两年的病例系列

背景

症状性莫顿神经瘤的最佳治疗方法仍不清楚;保守的方法有时是无效的,神经切除术患者的满意度很高。本研究的目的是评估莫顿神经瘤患者微创远端跖骨干骺端截骨术 (DMMO) 和经皮松解跖骨深横韧带 (DTML) 的结果。

方法

2018 年 1 月至 2019 年 11 月期间,27 名患者(29 英尺)在临床和放射学评估后被诊断为莫顿神经瘤,接受了 DMMO 和经皮 DTML 释放。主要临床结果是疼痛 (VAS) 和功能(AOFAS 评分)。次要结果包括患者满意度、并发症和影像学结果。患者随访至少两年。

结果

参与者的中位年龄为 66 岁(范围 48-79),随访时间为 28 个月(24-47)。手术后,疼痛 VAS 评分下降了 5.7 分 ( p  < .001),AOFAS 评分增加了 19.9 ( p  < .001)。有 1 例浅表感染,1 例患者需要切除神经瘤(神经切除术)。大多数患者 (89.7%) 感到满意,认为手术结果非常好。

结论

用微创远端跖骨干骺端截骨术和经皮松解跖骨深横韧带治疗莫顿氏神经瘤显示疼痛和功能显着改善,并发症发生率低,个人满意度高。

更新日期:2022-08-29
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