American Board of Internal Medicine (ABIM) Certification Practice Exam

Which patient population might require surgical intervention for Morton neuroma?

1. Those responding well to conservative measures

2. Only athletes with acute pain

3. Those not responding to at least 12 months of conservative therapy

4. All patients with Morton neuroma

The correct answer is: Those not responding to at least 12 months of conservative therapy

Surgical intervention for Morton neuroma is typically considered when conservative treatment options have failed to provide relief. This is particularly relevant for patients who have not responded to at least 12 months of conservative therapy, which may include measures such as padding, orthotics, physical therapy, and anti-inflammatory medications. The prolonged duration of conservative management helps to ensure that surgery is warranted, given that many cases can improve without surgical intervention. In contrast, some of the other patient populations mentioned may not necessarily need surgical intervention. For instance, those responding well to conservative measures would likely continue with non-surgical approaches, as they are finding relief from their symptoms. Athletes with acute pain may also benefit from temporary conservative treatment, allowing their condition to improve without needing immediate surgery. Lastly, not all patients with Morton neuroma require surgery; many can successfully manage their symptoms through non-invasive strategies, making surgery not a blanket requirement for every case. Thus, focusing the decision for surgical intervention on those who have exhausted conservative options for a significant period is a sound approach in clinical practice.