Clinical Results of Simultaneous Adjacent Interdigital Neurectomy in the Foot

Abstract

Fifteen patients (19 feet) who underwent simultaneous surgical excision of two primary interdigital neuromas in adjacent web spaces of the foot were studied retrospectively. There were 11 female patients (73%). The average age of the patients was 54.4 years. Other causes of multiple web space tenderness were excluded prior to surgical resection of both neuromas. At an average follow-up of 68.6 months (range, 32-113 months), 10 feet (53%) had complete resolution of symptoms and six feet (31%) had minimal residual symptoms. Three feet in two patients (16%) continued to have significant pain after surgery. One sequela of the procedure was dense sensory loss of the plantar aspect of the third metatarsal head to the tip of the third toe. There was also proximal dorsal sensory loss to the second, third, and fourth toes which was a function of the type of incision used. The sensory loss did not cause disability in the patients, but did cause some awkwardness with nail care. Resection of adjacent interdigital neuromas, although rarely indicated, can be expected to provide significant pain relief in 84% of patients, which is similar to results reported for resection of a single neuroma.

Disorders of the Lesser Toes

“…Interestingly, some tenderness to palpation in the surgically treated interspace was noted in 61% of patients, although they were infrequently aware of any pain in the region. Similar results were also reported by Giannini et al 54 and Benedetti et al 55 Mizel and Yodlowski 56 also highlighted the importance of examining the patient for concurrent MTP joint synovitis.…”

What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma?

“…The incidence of multiple ipsilateral neuromas ranges from 1.5% to 32% [12][13][14] in the literature. Very few studies have addressed the treatment of ipsilateral MN but do report good outcomes [15,16]. Both of the referenced studies addressed the outcome of surgery in adjacent ipsilateral neuromas.…”

A Prospective Randomized Controlled Trial of Plantar Versus Dorsal Incisions for Operative Treatment of Primary Morton’s Neuroma

“…Mechanical damage to the dorsal sensory nerve branches, for example, by the dorsal incision itself or by the use of retractors, may in part explain more sensory loss postoperatively in the dorsal group. 3 Patients should be well informed of this postoperative adverse event; if they are, numbness is usually well tolerated.…”