BACKGROUND: Morton's neuroma is a frequent cause of metatarsalgia. Operative 
treatment is indicated if nonoperative management has failed. The objective of 
the present study was to describe a technique of Morton's neuroma excision by a 
minimally invasive commissural approach and evaluate the long-term outcome and 
complications.
METHODS: A retrospective study of 108 patients with Morton's neuroma treated 
surgically with a commissural approach between September 1990 and December 2010 
was performed. The surgical technique is described. Clinical outcomes and 
complications were evaluated. The average follow-up was 121 months. Eleven 
patients were men and 97 women. The average age was 49.4 years; 56.8% neuromas 
were at the third space and 43.2% at the second space. Six patients presented 2 
neuromas in the same foot, and 9 patients had bilateral neuroma.
RESULTS: The visual analog scale (VAS) average pain score was 5.4 points 
preoperatively and 0.2 points at the final follow-up. The author found a 
significant difference between the VAS scores preoperatively and postoperatively 
(P < .01). Excellent and good satisfaction outcomes were achieved in 93.6%. The 
postoperative complication incidence was 3%.
CONCLUSION: The author believes a minimally invasive commissural approach has 
advantages over a dorsal or plantar incision. It is a simple and reproducible 
technique, with satisfactory outcomes, low complication rates, and a quick 
return to usual activities.
LEVEL OF EVIDENCE: Level IV, retrospective case series.