Neuroma approach

[Creflo]

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The Chang text recommends a plantar transverse approach that is distal to the met heads, does anyone have any experience with this method? Seems to me it may be hard to dissect proximal enough to get an adequate transection of the neuroma, but I haven't tried it yet.

Also, would you do a neuroma surgery on someone who you suspect has psoriatic arthritis, without any x ray signs of the arthritis?

Thanks

 

[NatCh]

1. I've only done neuroma excisions from a dorsal or plantar linear longitudinal incision, never transverse. What's the purported benefit over a standard longitudinal incision? Better exposure in a non-weight bearing area? I've used a transverse plantar incision for a Hoffman-Clayton though.

2. As far as I know, psoriatic arthritis is not necessarily a contraindication to neuroma surgery.

 

[Creflo]

1. I've only done neuroma excisions from a dorsal or plantar linear longitudinal incision, never transverse. What's the purported benefit over a standard longitudinal incision? Better exposure in a non-weight bearing area? I've used a transverse plantar incision for a Hoffman-Clayton though.

2. As far as I know, psoriatic arthritis is not necessarily a contraindication to neuroma surgery.

Reported benefit is that the scar is distal to met heads thus less weight bearing pressure. Text said there is a learning curve involved. I have had one plantar longitudinal incision that had scar pain at proximal aspect of incision, but not directly beneath met head.

 

[NatCh]

The plantar approach supposedly has a slightly higher success rate but the community standard where I live is to use a dorsal approach in a virgin foot and plantar approach on revisions. Patient acceptance of the dorsal approach has been very good.

Are you wanting to try the transverse approach?

 

[Creflo]

I've only done one neuroma since out of residency, was plantar approach. I think on this one I'm going to try dorsal approach. Haven't been able to find youtube videos or more info on the transverse approach yet, so am hesitant, especially since the author mentioned there is a learning curve. I feel like I could find the nerve from the plantar transverse approach, but dissecting far enough proximal from that incision seems difficult.