title: The Diagnosis and Treatment of Joplin's Neuroma.
abstract: Joplin's neuroma is a rare perineurial fibrosis of the medial plantar digital proper nerve arising from various etiologies but most commonly after bunion surgery. Treatment for this painful great toe problem remains controversial. It is our purpose to describe our experience with this chronic pain problem, considering it to be a neuroma requiring resection. A retrospective medical record review of 8 patients with medial hallux pain related to the digital nerve was performed. Each patient had failed to respond to >6 months of nonoperative therapy. At surgery, the medial digital nerve to the hallux was identified distally, the neuroma was resected distally, and the proximal end of the nerve was implanted into the arch of the foot in 7 (87.5%) of the 8 patients. At a mean follow-up of 25 (range 13 to 43) months, 6 results (75%) were excellent, 1 (12.5%) was good, and 1 (12.5%) was fair. The 1 fair result was in the only patient in whom the distal end of the divided nerve was not implanted proximally, according to the patient's request. In conclusion, surgical resection of the medial plantar nerve to the hallux with implantation of the proximal end of the nerve into the arch of the foot, can be expected to result in good to excellent relief of pain in 80% of the patients.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Melendez
authors.affiliation: Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Anup
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ALDellon@Dellon.com.
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006214:Hallux / Q000294:innervation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D010146:Pain / Q000209:etiology / Q000601:surgery; D059348:Peripheral Nerve Injuries / Q000150:complications; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
keywords: bunion deformity; digital nerve; neurolysis; pain; peripheral nerve