Surgical treatment of interdigital neuroma

Interdigital neuroma requires thorough clinical evaluation to ensure an accurate diagnosis. For cases refractory to conservative treatment, a neurectomy and release of the transverse metatarsal ligament is performed through a dorsal approach. Recurrent pain is a common complication, but its incidence may be minimized by diagnostic precision and meticulous surgical technique.     

Surgical approach to multiple interdigital nerve compressions

A surgical approach is described that permits access to 2 web spaces with a single incision along the common metatarsal, dividing distally at the proximal phalanx, as a novel y incision. This has been found to be useful in patients with adjoining interdigital nerve compressions.     

Treatment of recurrent neuroma of the interdigital nerve by implantation of the proximal nerve into muscle in the arch of the foot

A prospective study was done to evaluate the results of treating recurrent "Morton's" neuroma by a technique that combined resecting the interdigital neuroma through a plantar approach and implantation of the proximal end of the nerve into an intrinsic muscle in the arch of the foot. As a part of this study, quantitative sensory testing was done for the medial plantar and medial calcaneal nerves. Seventeen recurrent interdigital neuromas were resected in 13 patients. Pain was identified on physical examination as being due to neuromas located in the first (one), second (six), third, (eight) and fourth (two) web spaces. Seven of the 13 patients were found to have, by quantitative sensory testing and physical examination, an associated tarsal tunnel syndrome responsible for symptoms related to numbness in the foot in addition to the pain of the recurrent neuroma. These patients had tarsal tunnel decompression at the time of the neuroma resection. At a mean follow-up time of 33.8 months (range 24-42 months), done by direct physician interview and examination, 80% of the patients had excellent relief of symptoms, returned to their regular job, and wore usual footwear. Twenty percent of the patients had good relief of symptoms, worked at a different job, and had to change their footwear. It is concluded that recurrent pain after a dorsal interdigital neurectomy can be treated successfully through a plantar approach with implantation of the proximal end of the nerve into an intrinsic muscle. This study also identified an association of tarsal tunnel syndrome in 54% of this series of patients with recurrent Morton's neuroma.     

Operative treatment of interdigital Morton's neuroma

The Authors present their experience in the surgical treatment of Morton's neuroma via a dorsal approach. The assessed results have been very good in terms of a clear clinical improvement and no recurrences in all the treated cases. The histological examination carried out on all the removed samples have shown that the thickening of the nerve first occurs due to perineural fibrosis and successively associated with sclerohyalinosis of the tissue, which is in line with the already existing literature reports. The Authors of the article reckon the adopted surgical technique to be simple, safe and highly effective.     

Patient reported outcomes following revision neurectomy through a dorsal approach for recurrent interdigital neuroma

Interdigital neuroma is one of the commonest causes of metatarsalgia. The reported success rate after excision of a primary neuroma is 74%. Recurrent symptoms after neurectomy can be due to a recurrent interdigital neuroma. Recurrent interdigital neuromas can be diagnosed using sound clinical examination and ultrasonography. Surgical excision is the best treatment modality with varying success reported in the literature. We report on the clinical outcome following surgical excision of recurrent interdigital neuromas through a dorsal approach. All patients who had undergone excision of a recurrent interdigital neuroma by a single surgeon between 01/2010 and 12/2019 were identified. Inclusion criteria included patients having a preoperative ultrasound and postoperative histology report. The exclusion criteria were preexisting neuropathy or tarsal tunnel syndrome. Demographic data was collected, and a self-reported foot and ankle score questionnaire (SEFAS) was completed by the patient at their most recent follow-up. Twenty-three patients (25 feet) were included in the study. Mean time of follow-up was 75 (range 14–189) months. The mean age was 49 (range 15–71) years. Eleven (44%) recurrent neuromas were excised from the second webspace and 14 (56%) were excised from the third webspace. All excised masses were confirmed as recurrent neuromas histologically. Regarding the SEFAS score, 17 (73.93%) patients scored as excellent, one (4.34%) as good, three (13.04%) as fair, and two (8.69%) as poor. This long term follow-up study on outcomes after surgery for recurrent interdigital neuroma suggests that excision through a dorsal approach is an effective treatment option with a high patient satisfaction.     

Surgical treatment for primary interdigital neuroma

We studied 366 feet in 313 patients who underwent surgical treatment for a primary interdigital neuroma through a dorsal web-splitting incision. Three hundred five feet in 259 patients were available for follow up, which averaged 5.9 years (range: 2.8 to 13); 45.2% of these patients were completely satisfied, 33.8% were satisfied with minor reservations, 9.2% were satisfied with major reservations, and 11.8% were dissatisfied after the surgical procedure. Patient satisfaction was directly related to the size of the neuroma found at the time of operation. Bilateral procedures were associated with a higher rate of dissatisfaction. The third web space accounted for 91% of the neuromas.     

Morton’s neuroma – Current concepts review

Morton’s neuroma is a common pathology affecting the forefoot. It is not a true neuroma but is fibrosis of the nerve. This is caused secondary to pressure or repetitive irritation leading to thickness of the digital nerve, located in the third or second intermetatarsal space. The treatment options are: orthotics, steroid injections and surgical excision usually performed through dorsal approach. Careful clinical examination, patient selection, pre-operative counselling and surgical technique are the key to success in the management of this condition.     

Prevention of neuroma formation by Neodym Yag laser—Experimental observations

Summary The influence of Laser radiation on neuroma formation was investigated in rat sciatic nerves. Peripheral nerve trunks were divided by focussed Neodym Yag Laser and compared with those transected by microscissors. The nerves were re-exposed at different time intervals up to 240 days after initial operation. True neuroma formation could not be observed after laser transection. Sharp division resulted in widespread amputation neuromas consisting of regenerating axons and connective tissue. Neodym Yag laser radiation by its scattering effect may cause deep coagulation necrosis and thrombosis of vasa nervorum thus sealing the dome of the divided nerve trunk. The formation of amputation neuromas may be suppressed by laser application.     

听神经瘤显微手术保留面神经的经验

目的 探讨听神经瘤显微外科手术中面神经保留技术。方法 回顾性研究采用枕下乙状窦后经内耳道入路显微手术治疗的74例听神经瘤，对肿瘤的临床表现和影像学特征、面神经与肿瘤的病理解剖关系以及显微手术技巧进行系统分析。结果 肿瘤手术全切除72例，近全切除2例，面神经解剖保留67例，解剖未能保留7例，其中4例行颅内离断的面神经端-端吻合，术后无死亡病例。结论 显微神经外科技术是全切除听神经瘤安全有效的方法，熟悉面神经与肿瘤的病理解剖关系对于面神经解剖保留至关重要。     

听神经瘤显微手术治疗和面听神经功能保护的探讨

目的探讨听神经瘤显做于术治疗和面听神经功能保护的疗效。方法分析1999年10月至2002年10月收治经枕下乙状窦后内听道入路手术切除30例听神经瘤的资料，全部病例采用保留面听神经功能的显做外科技术。结果听神经瘤手术全切除29例（96．7％），次全切除1例；面神经解剖保留25例（83．3％），手术后12周面神经功能保留21例（70％）；耳蜗神经解剖保留25例83．3％），手术后2周有效听力保留2例（占术前存在有效听力患者的28．6％），有效听力丧失但可测听力保留15例。结论枕下乙状窦后经内听道入路的听神经显微手术，能够取得较好的肿瘤全切除率和面听神经功能保留率.     

Operative treatment of interdigital Morton’s neuroma

The Authors present their experience in the surgical treatment of Morton’s neuroma via a dorsal approach. The assessed results have been very good in terms of a clear clinical improvement and no recurrences in all the treated cases. The histological examination carried out on all the removed samples have shown that the thickening of the nerve first occurs due to perineural fibrosis and successively associated with sclerohyalinosis of the tissue, which is in line with the already existing literature reports. The Authors of the article reckon the adopted surgical technique to be simple, safe and highly effective.     

显微手术辅以内镜切除大型听神经瘤

目的 探讨神经内镜辅助的显微神经外科手术治疗大型听神经瘤的临床意义和手术方法。方法 16例大型听神经瘤，均施行患侧枕下乙状窦后入路显微手术切除，同时辅以神经内镜配合。结果 肿瘤全切除13例，次全切除者3例。面神经保留14例，短期并发症4例。所有患者神经功能均有不同程度的恢复。结论 神经内镜辅助显微手术切除大型听神经瘤，具有微创及提高肿瘤全切除率等优点。     

Operative treatment of interdigital neuroma. A long-term follow-up study

BACKGROUND: The literature regarding the outcome of surgical treatment of interdigital neuroma is incomplete. The purpose of this study was to assess the demographics associated with the presentation of an interdigital neuroma as well as the long-term clinical results of operative resection by a single surgeon. METHODS: A retrospective review of the patient records of one orthopaedic foot and ankle surgeon identified eighty-two patients who had been treated operatively for a primary, persistently painful interdigital neuroma more than three years previously. Of these eighty-two patients, sixty-six (seventy-one feet, seventy-four neuromas) returned at an average of 5.8 years for a follow-up evaluation, which included a review of the interval history since the surgery, a physical examination, a radiographic evaluation, and an assessment of the patient's satisfaction with the result of the surgery. RESULTS: Overall satisfaction was rated as excellent or good by fifty-six (85%) of the sixty-six patients. Forty-six (65%) of the seventy-one feet were pain-free at the time of final follow-up. The patients who had had either bilateral neuroma excision or excisions of adjacent neuromas in the same foot in a staged fashion had a slightly lower level of satisfaction, but this difference was not significant. While major activity restrictions following surgery were uncommon, mild or major shoe-wear restrictions were noted by forty-six of the sixty-six patients. Although there was subjective numbness in thirty-six of the seventy-one feet, the pattern of numbness was quite variable and it was bothersome in only four feet. CONCLUSION: With careful preoperative evaluation and patient selection, resection of a symptomatic interdigital neuroma through a dorsal approach can result in a high percentage of successful results more than five years following the procedure.     

外伤性神经瘤切除静脉桥接治疗神经瘤性残端痛

目的探讨外伤性神经瘤切除静脉桥接治疗神经瘤性残端痛的临床疗效.方法对56例外伤性神经瘤患者采用神经瘤切除静脉桥接手术.结果56例均获随访,时间3～18个月.参照尹维田等标准评定疗效：优45例,良7例,可4例,优良率为92．8％。结论采用静脉桥接治疗神经瘤性残端痛,可恢复神经连续性,预防神经瘤的再形成,临床效果确切.     

乙状窦后入路显微手术切除大型听神经瘤

目的探讨乙状窦后入路显微镜下切除大型听神经瘤的手术方法及临床意义。方法采用乙状窦后入路显微手术切除，对手术入路、显微手术技巧、手术后处理及并发症防治进行系统分析。结果临床应用15例，其中肿瘤全切除12例，次全切除3例，面神经解剖学保留13例，耳蜗神经解剖学保留6例。术后短期并发症3例，无死亡病例。结论乙状窦后入路显微镜下切除大型听神经瘤是安全的手术方法，对脑组织结构的创伤小，利于提高肿瘤全切除率并有效保护面神经和听神经的功能。     

Contribution of a new electrophysiologic test to Morton's neuroma diagnosis

BackgroundMorton's neuroma causes metatarsalgia due to the interdigital neuropathy. The small nerve diameter compromises their evaluation in image studies. To overcome this problem we propose a new electrophysiological test.MethodsWe conducted a prospective case–control study performing a orthodromic electroneurography using subdermal electrodes in controls and patients to assess the validity. Additionally all patients were tested with magnetic resonance. Some patients required surgery and subsequent histological evaluation.ResultsThe new ENG procedure showed higher sensitivity and specificity. Methodological standardization was easy and the test was well tolerated by the subjects.ConclusionsOur test demonstrated remarkable diagnostic efficiency, and also was able to identify symptomatic patients undetected by magnetic resonance, which underlines the lack of correlation between the size and intensity of the lesion. This new electrophysiological method appears to be a highly sensitivity, well-tolerated, simple and low-cost for Morton's neuroma diagnosis.     

A rare case of Pacinian corpuscle neuroma

The authors discuss an interesting case of a Pacinian corpuscle neuroma in the thumb of an elderly woman who presented with severe digital pain. The pain was initially attributed to osteoarthritis of the interphalangeal joint of the thumb. The clinical signs were very subtle. The patient had complete pain relief following excision of the tumour. Pacinian corpuscle neuromas are rare, with only about 70 cases reported in the literature. The histology, presenting features and associated conditions are discussed in detail. In addition to a neuroma or glomus tumour, Pacinian corpuscle hyperplasia should be considered in the differential diagnosis of digital or palmar pain of unknown etiology.