Patient related outcome measures (PROMs) in Morton's neuroma: conservative vs. surgical management at one-year

A. Faulkner, A. Mayne, G. Chami, F. Harrold

Introduction: Morton's neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton's neuroma using PROMs data in patients with follow-up to one year.

Method: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton's neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively, at 26-weeks and at 52-weeks post-operatively.

Results: 129 patients were included overall: 71 patients were conservatively managed and 58 surgically managed. 9 patients were converted from conservative to surgical management. In the conservative group pre-operative, 26-week and 52-week scores respectively: mean MOX-FQ = 54.08, 41.23 and 43.10. eqTTO scores = 0.513, 0.685, and 0.620. eqVAS scores = 69.68, 73.12, and 68.82. At 26 weeks 13 patients were satisfied, 19 dissatisfied, 39 missing. In the surgical group pre-operative, 26-week and 52-week scores respectively: MOX-FQ Pain scores = 56.92, 35.52, 40.73. eqTTO scores = 0.540, 0.747, and 0.690. eqVAS scores = 74.77, = 78.80, and 75.83. At 26 weeks 17 patients were satisfied, 13 dissatisfied, 28 missing.

Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton's neuroma patients. Early data suggests that surgical management offers favourable functional outcomes at 1-year. Further long-term PROMs data is required to fully validate this.