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Neuroma Excision - From the top or bottom?

Posted by Darlene on 8/02/04 at 21:47 (156794)

I know that most surgeons do this from the top. I've heard that there is less change of a stump neuroma if it is done from the bottom of the foot because the nerve could be taken back further and buried in the muscle tissue. I called Dr. Dellon's office and interestingly, he does this surgery from the bottom. What do you think?



Re: Neuroma Excision - From the top or bottom?

Dr. David S. Wander on 8/03/04 at 07:19 (156804)

Darlene, this is an excellent question. Statistically, there is less of a chance of stump neuroma if the end of the nerve is buried in muscle no matter where the incision is made. Plantar (bottom) incisions allow for an excellent visualization of the anatomy. This is always dependent on the skills and experience of the surgeon. Years ago, plantar incisions were less popular due to the possibility of scarring on the bottom of the foot. Have you tried conservative care for your neuroma?

Re: Dr. Wander

Darlene on 8/03/04 at 09:08 (156813)

Thank you for taking the time to respond.
A little history:
In January I had the 3rd interspace ligament cut using the 'blind' Koby surgery. It is the opinion of my new doctor (based on the MRI) that the nerve was nicked during the surgery. There is scar tissue both inside and outside of the nerve. In addition it seems that the nerve was injured in the next interspace over (the 2nd interspace). I never had pain there before. The MRI shows a proliferation of fibrous tissue but not a well formed neuroma in the 2nd interspace. I believe the pain in the 2nd interspace is worse than the neuroma pain. Then because of my altered gait, an accessory muscle enlarged in the tarsal tunnel area and I have tts symptoms on both feet, but much more on the surgical foot. The new doctor would like to take the neuroma out as a first step (he does it from the top). I am now more concerned about the tts symptoms and therefore contacted Dr. Dellon's office. I am concerned that neuroma surgery may make the tts symptoms worse due to swelling and more altered gait during recovery. What do you think?
You mention that plantar incisions were less popular in the past - are they being used more now?


Re: Dr. Wander

Dr. David S. Wander on 8/03/04 at 20:03 (156863)

Plantar incisions have gained more popularity, due to the ability to visualize the tissues better. Additionally, more is known now about wound healing and therefore there are steps that can be taken to lessen the chance of a painful plantar scar. It is difficult to determine which came first, the chicken or the egg. It is feasible that the 'neuroma' pain is coming from the tarsal tunnel. However, tarsal tunnel surgery can be very tricky, and should be avoided if possible. If you do have an accessory muscle in the tarsal tunnel, this can be contributing to your symptoms. Dr.Dellon is certainly knowledgable and an excellent person to speak with regarding your questions and concerns. Therefore I would see Dr. Dellon prior to considering any surgical options.