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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2001 June;25(2):85-92
Endoscopic decompression in the treatment of Morton's neuroma
Ronconi P., Baleanu P. M., Ragonesi F. P., Arcioni R., Pelagalli L.
Background. Morton's neuroma is a cause of metatarsalgia and certainly represents a most complex and interesting foot pathology. Different theories were formulated with regard to the etiology of Morton's ''neuroma'' and many different names were given to this particular pathology. It will take some time for the medical community to refer to this condition as a compressive sindrome of the intermetatarsal nerve. Aims: the purpose of this study is to evaluate the efficacy of endoscopic decompression of the intermetatarsal nerve (EDIN procedure) in patients with Morton's neuroma.
Methods. The study group included 70 patients (63 women and 7 men) that underwent a total of 87 endoscopic decompressions of the intermetatarsal nerve (53 unilateral and 17 bilateral) at the Foot Medical Hospital in Rome, Italy, from January 1997 through December 1999. The mean age of the patients was 58 years (range 25-66). Mean follow-up was 30 months (range 12-48). Preoperative and postoperative evaluation included accurate clinical, radiographic and echographic examinations.Patient satisfaction was measured with a modification of the University of Maryland 100 Point Painful Foot Center Scoring System. Grading was based on subjective patient replies to queries regarding pain, walking distance, stability in walking, type of shoe that the patient could wear etc.
Results. Patient satisfaction was rated with the Painful Foot Center Scoring System as follows: good to excellent 78% (55 patients), fair 6% (4 patients), poor 16% (11 patients). In 1 patient, painful scar tissue formation was observed. Nine patients required further surgery to remove the nerve.
Conclusions. The authors found the endoscopic decompression to be an effective procedure that offers good results for both the surgeon and the patient. It is a minimally invasive procedure, less traumatic and with less morbidity than neurectomy, allowing a much earlier return to normal activities than with traditional surgery. The EDIN procedure warrants an appropriate first level surgical implementation, before considering a nerve resection procedure.