Metatarsal sliding osteotomy is effective without altering plantar pressure in Morton's neuroma: Retrospective case series

Jae Wan Suh; Ho-Seong Jang; Kyu-Beom Kim; Ju Hyun Kim; Sung Joon Choi; Ka Ram Kim; In-Tak Chu; Hyun-Woo Park

doi:10.1016/j.jos.2023.10.012

Metatarsal sliding osteotomy is effective without altering plantar pressure in Morton's neuroma: Retrospective case series

J Orthop Sci. 2023 Nov 10:S0949-2658(23)00284-1. doi: 10.1016/j.jos.2023.10.012. Online ahead of print.

Authors

Jae Wan Suh¹, Ho-Seong Jang¹, Kyu-Beom Kim¹, Ju Hyun Kim¹, Sung Joon Choi¹, Ka Ram Kim¹, In-Tak Chu², Hyun-Woo Park³

Affiliations

¹ Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea.
² Department of Orthopaedic Surgery, Yonsei Gunwoo Hospital, Seoul, Republic of Korea.
³ Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea. Electronic address: m3artist@gmail.com.

PMID: 37953191
DOI: 10.1016/j.jos.2023.10.012

Abstract

Background: Various operative methods for the treatment of Morton's neuroma have been discussed, and osteotomy of the metatarsal bone has been reported recently. However, there has been no report of pedobarographic changes after metatarsal osteotomy. Pedobarographic changes of other metatarsal area after the surgery may cause transfer metatarsalgia, and thorough analysis of the pedobarographic data should be performed peri-operatively. The purpose of this study is to investigate the post-operative pedobarographic changes of sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma.

Methods: Forty patients (45 feet) who underwent metatarsal sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma from November 2013 to December 2021 were retrospectively reviewed. Proximal sliding osteotomy was performed at the proximal 3rd metatarsal bone through dorsal approach. Clinical outcomes were evaluated with American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal Interphalangeal Scale (AOFAS LMIS), Foot Function Index (FFI), and Visual Analogue Scale (VAS). Plain radiograph and pedobarogram were performed to evaluate the radiologic and pedobarographic outcomes.

Results: AOFAS score was improved from 52.8 ± 9.0 (18-62) to 88.8 ± 9.8 (78-100) and FFI was improved from 61.8 ± 4.9 (50-70) to 32.2 ± 5.1 (23-42) on average. The 3rd metatarsal bone was shortened by 3.1 ± 0.8 mm and dorsally shifted by 1.5 ± 0.4 mm after the surgery. Plantar intermetatarsal distances between 2nd and 3rd and 3rd and 4th metatarsal heads were significantly increased post-operatively. Average forefoot pressure and maximum pressure of the 2nd to 4th metatarsal head were not significantly changed between pre-operatively and post-operatively.

Conclusion: Proximal metatarsal sliding osteotomy of the 3rd metatarsal bone shows a satisfactory result in both clinical and pedobarographical evaluations. It could be an effective treatment of permanent indirect decompression of Morton's neuroma with avoiding recurred neuroma, adhesion of tissue, paresthesia, and transfer metatarsalgia.

Keywords: Metatarsal bones; Morton neuroma; Osteotomy.