Management of Morton’s “Neuroma” Mr A Craig, Mr N Gogi, Mr S Sturdee 1

Introduction Relatively common and well documented but misnomered forefoot phenomenon, first mentioned in early 19th century. Step-wise management. Footwear & insole Injection (steroid, alcohol) Surgical excision 2

Basics No histological signs of either inflammation or neoplasia… not actual neuroma or neuritis. Mixture of degeneration and fibrosis. Symptoms of neuralgia in the common plantar digital nerve to the affected webspace, usually 3rd. Pathognomic Mulder’s click. 3

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Aims of audit Aimed for approx 50 cases. Ascertain basic demographics of incidence, (typically described as middle-aged females). What conservative treatment did each patient receive, and what was the success rate. Success/Recurrence rate of surgery. 5

Method Retrospective audit of outcome, by means of case- note interrogation. Case list compiled from Consultant’s new patient clinic lists. 6

Results 40 cases of Morton’s Neuroma diagnosed on presentation in 38 patients. Mean age on presentation – 47.11 years Age range on presentation – 17-72 years Gender ratio female:male – 4:1 7

Results 11 cases reported resolution with use of an insole alone (27.5%). A further 5 cases settled following subsequent steroid injection (12.5%). 22 cases underwent surgical excision (55%). From these 22; 1 case reported persistent symptoms post-op. 8 (2 cases awaiting surgery)

Results 9

Conclusions Conservative measures have a clear role with 40% of cases achieving resolution with these measures alone. Surgical management has a high success rate, with only 1 case from 22 (4.55%) reporting persistence of symptoms on follow-up. 10

Questions 11