Orthopedics & Rheumatology

Biography

Biography: Rajiv Limaye

Abstract

Introduction Pain in the inter-metatarsal region in the foot due to Morton’s neuroma is a very common presentation in both orthopaedic and rheumatology clinics. Various techniques have been described in the literature for the treatment of this very common condition, including surgery. There is also variation amongst surgeons using various surgical approaches. There are benefits and disadvantages of various approaches. We aimed at reviewing the efficiency of neurectomy by using a plantar approach. 20 patients were surgically treated using this approach. Patients and Methods A series of 20 feet in 20 patients were included in this study. These patients had confirmed Morton’s neuroma in one or two interspaces in their feet. The diagnosis was done by clinical examination followed by an ultra sound examination. In addition, these patients had either an orthotic support or an inter-metatarsal injection as a prior method of treatment. The rest of their feet examination was found to be normal and there were no other causes found to be contributory for their forefoot pain. All of these patients were surgically treated using a plantar incision (either vertical or horizontal) and a neurectomy was performed. The mean age was 47 years. There were 14 females and 6 males. Out of our cohort, 60% of the cases had two level involvement (second/third interspace and third/fourth interspace) and 40% had only one space involvement (second and third interspace.) The average time to resolve the symptoms was 4.5 weeks. The mean follow-up was 8 months. The results were analysed by an independent surgeon clinically using AOFAS scores. The VAS and subjective outcome score were also performed. Results The mean AOFAS score improved from 39 pre-op (median 37, range 20 - 70) to 80 post op. (median 77, range 70 - 93). The mean VAS improved from 40 to 92. Out of the total patients, 90% were very satisfied/ satisfied. The time for resuming normal activities was found to be 4.5 weeks in 80% of patients. There were no cases of infection, residual pain beneath the scar and wound complications. Two patients had no benefit of the procedure and these were rescanned to show evidence of post-operative scarring and bursitis and no further surgery was offered to these patients. There was no evidence of recurrence of neuroma in these patients. The remaining patients were happy at the time of discharge. Conclusion This small series represents the author’s preferred approach towards this common problem in orthopaedics and rheumatology. The authors conclude that neurectomy performed by a plantar approach is satisfactory, because of better neuroma exposure, satisfactory soft tissue healing, faster return to normal activities and pain improvement post operatively.