SAMPLE OF CLINICAL TUTORIAL VOL. II - NEUROMA

Surgical Technique

An incision is made on the dorsal aspect of the involved intermetatarsal area, extending from the distal one-third of the metatarsal shaft to just into the interdigital space (Fig.3A).

Figure 3A.

The incision is deepened and retracted. The superficial vessels are isolated and ligated (Figure 3B-C).

Figure 3B-C.

The incision is deepened and retracted. The surgeon then spreads the 3^rd and 4^th toes and using his index finger, pushes the tissues up in the area just anterior to the metatarsal heads (Fig. 3D). The fatty tissues are retracted and the vessels in the area are preserved with gentle retraction. The neuroma, which usually presents, as a glistening, grayish, lumpy, indurated mass, will then be easily identified in the anterior space of the wound. Sometimes a neuroma will not be found, but rather, an induration of the nerve which is called a perineural fibrosis.

Figure 3D.

The mass is then carefully underscored and freed from the surrounding tissues. The indurated common digital nerve is then tracked proximally as it passes underneath the transverse metatarsal ligament (Figure 3E).