Dorsal yaklaşım ile Morton nöroma eksizyonu cerrahisi orta dönem sonuçları

Yıl 2019, Cilt: 4 Sayı: 1, 14 - 16, 15.03.2019

Haluk Çelik , Metin Uzun

https://doi.org/10.25000/acem.486816

Cited By: 1

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

Öz

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.

Anahtar Kelimeler

Morton, interdigital neuroma, metatarsalgia

Kaynakça

• 1. Di Caprio F, Meringolo R, Shehab Eddine M, Ponziani L. Morton's interdigital neuroma of the foot: A literature review. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons 2018;24(2): 92-8
• 2. Kasparek M, Schneider W. Surgical treatment of Morton's neuroma: clinical results after open excision. International orthopaedics 2013;37(9): 1857-61
• 3. Civinini F. Su d’un nervoso gangliare rigonfiamento alla pianta del piede. Lettera anatomica al Dr. Salomone Lampronti, Pistoia, Tip Bracali. 1835;
• 4. Morscher E, Ulrich J, Dick W. Morton's intermetatarsal neuroma: morphology and histological substrate. Foot & ankle international 2000;21(7): 558-62
• 5. Bennett GL, Graham CE, Mauldin DM. Morton's interdigital neuroma: a comprehensive treatment protocol. Foot & ankle international 1995;16(12): 760-3
• 6. Graham CE, Graham DM. Morton's neuroma: a microscopic evaluation. Foot & ankle 1984;5(3): 150-3
• 7. Zanetti M, Strehle JK, Kundert HP, Zollinger H, Hodler J. Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions. Radiology 1999;213(2): 583-8
• 8. Pace A, Scammell B, Dhar S. The outcome of Morton's neurectomy in the treatment of metatarsalgia. International orthopaedics 2010;34(4): 511-5
• 9. Giannini S, Bacchini P, Ceccarelli F, Vannini F. Interdigital neuroma: clinical examination and histopathologic results in 63 cases treated with excision. Foot & ankle international 2004;25(2): 79-84
• 10. Coughlin MJ. Common causes of pain in the forefoot in adults. The Journal of bone and joint surgery British volume 2000;82(6): 781-90
• 11. Nery C, Raduan F, Del Buono A, Asaumi ID, Maffulli N. Plantar approach for excision of a Morton neuroma: a long-term follow-up study. The Journal of bone and joint surgery American volume 2012;94(7): 654-8
• 12. Dereymaeker G, Schroven I, Steenwerckx A, Stuer P. Results of excision of the interdigital nerve in the treatment of Morton's metatarsalgia. Acta orthopaedica Belgica 1996;62(1): 22-5
• 13. Coughlin MJ, Pinsonneault T. Operative treatment of interdigital neuroma. A long-term follow-up study. The Journal of bone and joint surgery American volume 2001;83-A(9): 1321-8
• 14. Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Long-term evaluation of interdigital neuroma treated by surgical excision. Foot & ankle international 2008;29(6): 574-7
• 15. Schroven I, Geutjens G. Results of excision of the interdigital nerve in the treatment of morton’s metatarsalgia. The Foot 1995;5: 196-8
• 16. Diez EM, Mas SM, Pi, JF, Aramburo F. Comparative results of two different techniques in the treatment of the Morton’s neuroma. The Foot 1999;9: 134-7
• 17. Mann RA, Reynolds JC. Interdigital neuroma-a critical clinical analysis. Foot & ankle 1983;3(4): 238-43