Treatment of recurrence of symptoms after excision of an interdigital neuroma. A retrospective review.
During a six-year period (January 1996 to January 2002), we re-explored 60 interspaces (49 patients, 49 feet) for recurrence or persistent symptoms after one or more previous procedures for excision of an interdigital neuroma. Ten patients underwent concomitant excision of a primary neuroma from an adjacent interspace, and 19 underwent concomitant forefoot surgery. The mean follow-up was 39.7 months (6 to 79). Evaluation included review of records and radiographs, clinical assessment, and a questionnaire regarding satisfaction, pain, restriction of footwear and activity. In total, 15 patients (30.7%) were completely satisfied, 13 (26.5%) were satisfied with minor reservations, ten (20.4%) were satisfied with major reservations and 11 (22.4%) were dissatisfied with the outcome. Of the 49 patients, 28 (57.2%) had no or mild pain, 29 (59.2%) had moderate or severe restriction of footwear and eight (16.3%) had moderate restriction of activity. Intra-operative findings, simultaneous surgery to adjacent interspaces, concomitant forefoot surgery and previous re-explorations did not significantly influence the outcome. Persistent or recurrent symptoms after transection of a nerve present a challenging problem for both the surgeon and patient. It is essential that there is a thorough pre-operative discussion with the patient, providing the rates of failure and the increased likelihood of restriction of footwear and activity after revision surgery.
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Department of Orthopaedic Surgery, The Union Memorial Hospital, #400, 3333 North Calvert Street, Baltimore, Maryland 21218, USA.
Myerson
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D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000601:surgery*; D005545:Forefoot, Human / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000601:surgery*; D009463:Neuroma / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D014034:Toes; D016896:Treatment Outcome