Dorsal yaklaşım ile Morton nöroma eksizyonu cerrahisi orta dönem sonuçları

Öz

Amaç: Morton’s nöroma ön ayağın ilerleyici ve ağrılı bir hastalığı olup, cerrahi dışı yöntemler başarısız olduğunda nöroma eksizyonu tedavi seçenekleri arasındadır. Bu çalışmada dorsal yaklaşım ile nöroma eksizyonu yapılan olgularda fonksiyonel sonuçlar, komplikasyonlar ve devam eden şikayetler araştırılmıştır.

Yöntemler: Morton’s nöroma tanısı ile dorsal nöroma eksizyonu yapılan  27 hasta (21 kadın) çalışmaya dahil edildi. Ortalama yaş 49 yıl (Yaş aralığı 24-74 yıl) ortalama takip süresi 52 ay idi (Yaş aralığı 24-96 yıl). Klinik skorlar interdigital nöroma skorlama sistemine göre değerlendirildi. Hastalar son takiplerinde ağrı şiddeti, ayakkabı değişiklikleri ve duyu problemleri açısından sorgulandı.

Bulgular: Cerrahi öncesi 20 puan olan ortalama interdigital nöroma skorlaması, son takipte ortalama 62 puan olarak saptandı (p<0.05). Onbir olguda (%41) mükemmel, 13 olguda (%48) iyi, bir olguda (%4) orta ve iki olguda (%7) kötü sonuç elde edildi. Onaltı olguda (%59) günlük hayatı etkilemeyen his kaybı saptandı. Yedi hasta (%26) zaman zaman ayakkabı değişikliği yapmaları gerektiğini bildirirken, bir hasta (%4) özel ayakkabı dışında ayakkabı kullanamadığını ifade etti. 19 hastada (%70) hiç ağrı saptanmadı.

Sonuç: Dorsal yaklaşım ile nöroma eksizyonu, Morton nöroma tedavisinde etkili bir tedavi yöntemidir. Hafif dereceli ayakkabı intoleransı ve his kaybı sık devam eden şikayetler arasında olup klinik skorları ile ilişki saptanmamıştır.

Anahtar Kelimeler

• morton,interdigital nöroma,metatarsalji

Dorsal approach for excision of Morton’s interdigital neuroma: A mid-term follow-up study

Abstract

Aim: Morton’s neuroma is a paroxysmal neuralgia of forefoot and when nonsurgical treatment is unsuccessful, neuroma excision is indicated. The purpose of the present study was to evaluate the outcomes, complications and existing symptoms following an excision of the neuroma using dorsal approach.

Methods:  The study evaluated 27 patients (21 women) with an average age of 49 years (range, 24-74) and an average follow-up of 52 months (range, 24-96). The clinical diagnosis was confirmed by history and clinical evaluation. Clinical outcomes were assessed using the interdigital neuroma score and the patients were asked in terms of the level of pain, shoe modification, and sensorial problems.

Results: Average interdigital neuroma score improved from 20 to 62 points following the surgery (p<0.05). An excellent interdigital neuroma score was reported in 11 cases (41%), well in 13 (48%) and fair in one patient (4%); and two patients (7%) had a poor result with a similar pain prior to surgery.  Numbness was reported in 16 patients (59%) without a restriction in daily life. Seven patients (26%) reported mild limitation with fashionable shoes and one patient (4%) reported severe intolerance in footwear. 19 patients (70%) were completely pain-free.

Conclusion:  Surgical excision via dorsal approach is an effective method for the treatment of Morton’s neuroma. In spite of the fact that mild degree shoe modification and numbness were the most common existing symptoms after the surgery, clinical scores were not related to ongoing symptoms.

Keywords

• Morton,interdigital neuroma,metatarsalgia

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