Longitudinal plantar approach for excision of interdigital perineural fibroma of the foot: A case series and literature review

Background: There is an array of clinically and academically derived opinion as to the correct surgical approach to the intermetatarsal space, most frequently to excise a symptomatic interdigital perineural fibroma (aka Morton’s Neuroma). The purpose of this retrospective case series was to evaluate the patient outcomes, and sequelae following a longitudinal plantar incision for excision of interdigital perineural fibroma. Method: This is a retrospective case series of forty-two patients who underwent excision of interdigital perineural fibroma utilizing a longitudinal plantar incision between 2012-2014. All patients were reviewed at two weeks, four weeks and six months post operatively. Patient and clinician outcome measures were captured by means of the Manchester-Oxford Foot Questionnaire (MOXFQ) and Patient Satisfaction Questionnaire 10 (PSQ-10). Results: Forty two patients (forty eight excisions) were assessed both pre operatively and post operatively. 95.2 percent of patients felt their foot was better or much better at six months post operatively. The average post-operative PSQ-10 score was 85.05 (SD +/14.3). A significant reduction in all three MOXFQ domains was observed. Four patients had surgical sequelae; only one patient reported no improvement in pain post operatively. No patients reported worsening symptoms. Conclusion: Producing excellent patient outcomes with only minimal complications, this case series substantiates the growing literature showing that excision of interdigital perineural fibroma through a longitudinal plantar incision is both safe and effective.