M J Coughlin1, T Pinsonneault. 1. St. Alphonsus Regional Medical Center, Boise, Idaho, USA. footmd@aol.com
Abstract
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.
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.