Plantar versus dorsal incision in the treatment of primary intermetatarsal Morton's neuroma

Background: Only few studies have compared plantar and dorsal incisions in the treatment of primary intermetatarsal Morton's neuroma (PIMN). The results and guidelines are, however, still controversial, mainly due to confounding factors and study design. The present study is an attempt to systematically compare the two approaches. Materials and Methods: With a 2- to 5-year followup, we retrospectively compared the results of 125 patients (132 feet) with PIMN. All specimens had histology assessments. Longitudinal plantar incisions were performed by one experienced surgeon (n = 69) and dorsal incisions by another (n = 56). Records were reviewed, questionnaires evaluated, and physical examinations performed by one of two independent orthopaedic surgeons. Results: Histology verified nerve resections in all specimens except in three cases of missed nerves in the dorsal group. There were significant differences, in favor of the plantar group, regarding long-term sensory loss, postoperative sick-leave weeks and complications. The clinical outcome regarding postoperative pain at followup and overall satisfaction rating were similar. Conclusion: We conclude that the two surgical approaches were comparable for clinical outcome and patient satisfaction at followup, whereas significant differences, in favor of plantar incisions, were present regarding residual sensory loss and number of complications. The more serious complication with the dorsal approach, missed neuroma, may result in an increased risk of failure with the dorsal incision.