Clinical audit of the surgical management of plantar digital neuroma

Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

“…20,24 Mulder's click test has long been established as a reliable test for the presence of PDN. 20,21,24,27 Most cases of PDN can be diagnosed clinically 5,8,15 with those being considered for surgical or invasive intervention having the diagnosis confirmed by ultrasound or magnetic resonance imaging (MRI) if necessary. 9 This said, clinical tests may be just as useful especially in detecting smaller lesions which can be missed by ultrasound and MRI, yet which cause the sufferer just as much discomfort.…”

“…While the exact cause of PDN remains unclear, [5][6][7] it is most likely a mechanically induced neuropathy 5,[8][9][10][11] caused by entrapment of the nerve as it passes inferiorly to the transverse inter-metatarsal ligament (IML). 7,[11][12][13] The clinical presentation, positive clinical tests, and a good history are usually sufficient to make an accurate diagnosis.…”

“…7,[11][12][13] The clinical presentation, positive clinical tests, and a good history are usually sufficient to make an accurate diagnosis. 5,12 Patients who present with this condition will commonly complain of a burning or lancing pain, with or without accompanying paresthesia in the ball of the foot which is relieved by rest and the removal of footwear. 5,9 Classically, the pain is in the third IM space but is not infrequently found in the second IM space and rarely in the first or fourth spaces.…”

“…5,12 Patients who present with this condition will commonly complain of a burning or lancing pain, with or without accompanying paresthesia in the ball of the foot which is relieved by rest and the removal of footwear. 5,9 Classically, the pain is in the third IM space but is not infrequently found in the second IM space and rarely in the first or fourth spaces. The severity of the pain can fluctuate greatly, both from patient to patient and from time to time in each patient.…”

“…18 It remains a difficult condition to resolve and is often a limiting factor in the individuals leisure pursuits and work life. 5,19 There is as yet very little empirical evidence that supports the use of one therapy over another and, despite surgery being generally accepted as the gold standard treatment, there is to date no evidence that it results in better patient outcomes than conservative care. Therefore, the purpose of this retrospective case series is to describe treatment outcomes for patients with PDN who were treated using foot manipulation.…”