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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

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Abstract

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.

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Acknowledgements

We thank Rodrigo Tonan for enriching the content of the article through the impeccable medical illustrations.

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Authors and Affiliations

  1. Department of Orthopaedics, Rheumatology and Traumatology, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil

    Gustavo Sato & Mauro Cesar Mattos e Dinato

  2. Instituto Vita, São Paulo, Brazil

    Gustavo Sato, Gabriel Ferraz Ferreira, Mauro Cesar Mattos e Dinato & Miguel Viana Pereira Filho

  3. Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil

    Gabriel Ferraz Ferreira & Miguel Viana Pereira Filho

  4. Minimally Invasive Foot Ankle Society (MIFAS By GRECMIP), Merignac, France

    Gabriel Ferraz Ferreira

  5. Department of Orthopaedics and Traumatology, Prevent Senior, São Paulo, Brazil

    Davy Sevilla & Carolinne Nascimento Oliveira

  6. Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Thomas Lorchan Lewis

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  1. Gustavo Sato
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  2. Gabriel Ferraz Ferreira
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  6. Mauro Cesar Mattos e Dinato
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  7. Miguel Viana Pereira Filho
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Contributions

All authors contributed equally to this study.

Corresponding author

Correspondence to Miguel Viana Pereira Filho.

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Ethics approval

This study was approved by the Research Ethics Committee (Plataforma Brasil CAAE number 33673120.7.0000.5463).

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All patients included in the study have given written consent to participate.

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All patients included in the study have given written consent to have their personal data published.

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The authors declare no competing interests.

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Level of evidence: IV, case series

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Sato, G., Ferreira, G.F., Sevilla, D. et al. 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 (SICOT) 46, 2829–2835 (2022). https://doi.org/10.1007/s00264-022-05557-0

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