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Scientific Articles   |    
Plantar Approach for a Morton NeuromaSurgical Technique
Caio Nery, MD1; Fernando Raduan, MD1; Angelo Del Buono, MD2; Inacio Diogo Asaumi, MD1; Nicola Maffulli, MD, MS, PhD, FRCS(Orth)3
1 Department of Orthopaedic Surgery, Federal University of São Paulo, R. Pedro de Toledo 783, Fifth Floor, Vila Mariana, São Paulo, São Paulo, Brazil 04039-032. E-mail address for C. Nery: caionery@uol.com.br. E-mail address for F. Raduan: fernando@raduan.com.br. E-mail address for I.D. Asaumi: igasaumi@uol.com.br
2 Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy. E-mail address: a.delbuono@unicampus.it
3 Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. E-mail address: n.maffulli@qmul.ac.uk
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Based on an original article: J Bone Joint Surg Am. 2012 Apr 4;94(7):654-8.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Jul 25;2(3):e14 1-6. doi: 10.2106/JBJS.ST.L.00006
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Extract

Overview
Introduction

The plantar approach for management of a Morton neuroma allows the transverse metatarsal ligament to be spared, decreases the risk of damage to the dorsal cutaneous nerve branches, and has a low rate of complications with results comparable with those of other approaches.

Step 1: Incision

Make a transverse plantar skin incision distal to the metatarsal weight-bearing area.

Step 2: Exposure

Excise the connective tissues around the neuroma and expose the common digital nerve as far proximally as possible.

Step 3: Resection

Identify the resection point over the metatarsal neck and cut the neural branches as proximal and as distal as possible.

Step 4: Closure

Suture the fat pad using inverting absorbable sutures and the skin using nonabsorbable monofilament sutures.

Results

We assessed 160 of 168 patients who had undergone surgical excision of a Morton neuroma; the median duration of follow-up was 7.1 years13.

What to Watch For

Indications

Contraindications

Pitfalls & Challenges

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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