Which surgical procedure is used to treat of interdigital neuritis?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

Surgical excision of the interdigital nerve and release of the intermetatarsal ligament with a dorsal or plantar approach results in a high percentage of successful results. The dorsal approach is recommended because of fewer potential complications and because it allows early weight bearing. Patients should be counseled preoperatively that varying degrees of postoperative numbness are commonly associated with resection of a Morton neuroma. Other surgical options include isolated intermetatarsal ligament release.

Most surgeons in the United States perform a primary surgical procedure via a dorsal approach. An incision approximately 3 cm long is centered in the relevant interspace, starting from the metatarsal head level and extending distally into the webspace. Blunt dissection into the webspace and placement of a lamina-style spreader reveals the intermetatarsal ligament. The proximal and distal aspects of the ligament are identified and released sharply.

An enlarged nerve may be identified readily beyond the ligament. Smaller nerves are more difficult to identify. In most cases, intertwining vessels require careful dissection and protection. The digital branches are identified and are sharply amputated distally. The nerve is then followed proximally, gently pulled distally, sharply amputated as far proximally as is visible, and allowed to retract into the deep soft tissues.


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