Ultrasound-Guided Decompression of the Intermetatarsal Nerve for Morton's Neuroma: A Novel Closed Surgical Technique.

Abstract

BACKGROUND:

This study describes the technique for decompression of the intermetatarsal nerve in Morton's neuroma by ultrasound-guided surgical resection of the transverse intermetatarsal ligament. This technique is based on the premise that Morton's neuroma is primarily a nerve entrapment disease. As with other ultrasound-guided procedures, we believe that this technique is less traumatic, allowing earlier return to normal activity, with less patient discomfort than with traditional surgical techniques.

METHODS:

We performed a pilot study on 20 cadavers to ensure that the technique was safe and effective. No neurovascular damage was observed in any of the specimens. In the second phase, ultrasound-guided release of the transverse intermetatarsal ligament was performed on 56 patients through one small (1- to 2-mm) portal using local anesthesia and outpatient surgery.

RESULTS:

Of the 56 participants, 54 showed significant improvement and two did not improve, requiring further surgery (neurectomy). The postoperative wound was very small (1-2 mm). There were no cases of anesthesia of the interdigital space, and there were no infections.

CONCLUSIONS:

The ultrasound-guided decompression of intermetatarsal nerve technique for Morton's neuroma by releasing the transverse intermetatarsal ligament is a safe, simple method with minimal morbidity, rapid recovery, and potential advantages over other surgical techniques. Surgical complications are minimal, but it is essential to establish a good indication because other biomechanical alterations to the foot can influence the functional outcome.

• Authors: Alvaro Iborra-Marcos, Manuel Villanueva-Martinez, Stephen L Barrett, Pablo Sanz-Ruiz
• Journal: Journal of the American Podiatric Medical Association (J Am Podiatr Med Assoc) Vol. 110 Issue 6 (Nov 01 2020) ISSN: 1930-8264 [Electronic] United States
• PMID: 33301594 (Publication Type: Journal Article)

Topics

• Decompression
• Foot Diseases
• Humans
• Morton Neuroma (surgery)
• Neuroma (diagnostic imaging, surgery)
• Pilot Projects
• Ultrasonography
• Ultrasonography, Interventional