se injections do not create a sensible means of long term relief and do little to address the apex of the pathology. In addition, steroid injections may directly damage the nerve and may cause other deleterious effects, such as plantar plate ruptures . Further, no other primary nerve entrapment in the human body is treated by open resection .
It is well known that higher complication rates are found when any type of peripheral nerve destruction or ablation procedure is performed when compared to neurolysis. The likelihood of the development of peripheral nerve injuries or amputation neuromas is rare via the use of the EDIN technique. Our rate of conversion to open neurectomy of 3.6% further confirms this.
The authors postulate that the lower success rate seen in 2nd interspace decompression in comparison to 3rd interspace decompression is likely due to the increased complexity of pathomechanics occurring in the 2nd ray, as well as the potential for undiagnosed, concomitant conditions to be present upon clinical diagnosis of Morton’s entrapment. The diagnosis of Morton’s entrapment is often based solely on clinical signs and symptoms . Conditions that mimic peripheral nerve entrapments need to be ruled out when an entrapment is suspected in the 2nd interspace, a common location of such pathologies. Thus, it is imperative that coexisting conditions of equinus, capsulitis, or metatarsalgia due to partial plantar plate rupture, be appreciated pre-operatively, if successful surgical outcomes are to be achieved.
There can be a significant learning curve with the EDIN technique, but once it is overcome surgeon reproducibility is high. The one surgeon outlier in our multi surgeon study had a higher number of bilateral cases, which may have contributed to an overall lower efficacy rate. However, it is important to note that the conversion to open neurectomy was the lowest in the group.
Endoscopic decompression of intermetatarsal nerve (EDIN), as evidenced by postoperative subjective ratings, is a viable and efficacious technique for the treatment of Morton’s entrapment, often referred to erroneously as Morton’s Neuroma. EDIN is not only favorable in success rate and complications to open nerve resection procedures, but also has high surgeon reproducibility once the learning curve is overcome.
- E. E. Larson, S. L. Barrett, B. Battiston, C. T. Maloney Jr. and A. L. Dellon, “Accurate Nomenclature for Forefoot Nerve Entrapment: A Historical Perspective,” Journal of the American Podiatric Medical Association, Vol. 95, No. 3, 2005, pp. 298-306.
- F. Goldman, “Intermetatarsal Neuromas: Light and Electron Microscopic Observations,” Journal of the American Podiatry Association, Vol. 70, No. 6, 1980, p. 265.
- A. E. Hoadley, “Six Cases of Metatarsalgia,” Chicago Medical Recorder, Vol. 5, 1893, pp. 32-37.
- K. Y. Nissen, “Plantar Digital Neuritis, Morton’s Neuralgia,” Journal of Bone and Joint Surgery, Vol. 30-B, No. 1, 1948, pp. 84-94.
- M. L. Root, W. P. Orien and J. H. Weed, “Normal and Abnormal Function of the Foot,” Clinical Biomechanics Corp., Los Angeles, 1977.
- C. E. Graham and D. M. Graham, “Morton’s Neuroma: A Microscopic Analysis of the Interdigital Neuroma,” Foot and Ankle, Vol. 5, No. 3, 1984, pp. 150-153.
- I. J. Alexander, K. A. Johnson and J. W. Parr, “Morton’s Nueroma: A Review of Recent Concepts,” Orthopedics, Vol. 10, No. 1, 1987, pp. 103-106.
- M. J. Shereff and D. A. Grande, “Electron Microscopic Analysis of the Interdigital Neuroma,” Clinical Orthopedics, Vol. 271, 1991, pp. 296-299.
- G. Gauthier, “Thomas Morton’s Disease: A Nerve Entrapment Syndrome,” Clinical Orthopedics, Vol. 142, 1979, pp. 90-92.
- P. F. Diebold, B. Daum, V. Dang-Vu and M. Litchinko, “True Epineural Neurolysis in Morton’s Neuroma: A 5-Year Follow Up,” Orthopedics, Vol. 19, No. 5, 1996, pp. 397-400.
- A. L. Dellon, “Treatment of Morton’s Neuroma as a Nerve Compression,” Journal of the American Podiatric Medical Association, Vol. 86, No. 8, 1992, pp. 399-402.
- S. L. Barrett and T. T. Pignetti, “Endoscopic Decompression for Intermetatarsal Nerve Entrapment—The EDIN Technique: Preliminary Study with Cadaveric Specimens; Early Clinical Results,” Journal of Foot and Ankle Surgery, Vol. 33, No. 5, 1994, pp. 503-508.
- S. L. Barrett and A. S. Walsh, “Endoscopic Decompression of Intermetatarsal Nerve Entrapment: A Retrospective Study,” Journal of the American Podiatric Medical Association, Vol. 96, No. 1, 2006, pp. 19-23.
- S. L. Barrett, “Endoscopic Nerve Decompression,” Clinics in Podiatric Medicine and Surgery, Vol. 23, No. 3, 2006, pp. 579-595. doi:10.1016/j.cpm.2006.05.002
- N. Espinosa, J. D. Seybold, L. Jankauskas, et al., “Alcohol Sclerosing Therapy Is Not an Effective Treatment for Interdigital Neuroma,” Foot and Ankle International, Vol. 32, No. 6, 2011, pp. 576-580. doi:10.3113/FAI.2011.0576
- J. Greenfield, J. Rea and F. W. Llfed, “Morton’s Interdigital Neuroma: Indications for Treatment by Local Injections versus Surgery,” Clinical Orthopedics, Vol. 185, 1984, pp. 142-144.
- C. L. Hankins, M. G. Brown, R. A. Lopez, et al., “A 12-Year Experience Using the Brown Two-Portal Endoscopic Procedure of Transverse Carpal Ligament Release in 14,722 Patients: Defining a New Paradigm in the Treatment of Carpal Tunnel Syndrome,” Plastics and Reconstructive Surgery, Vol. 120, No. 7, 2007, pp. 1911- 1921. doi:10.1097/01.prs.0000287287.85044.87
- S. E. MacKinnon and A. L. Dellon, “Surgery of the Peripheral Nerve,” Thieme Medical Publishers, New York, 1988.
- C. Villas, B. Florez and M. Alfonso, “Neurectomy versus Neurolysis for Morton’s Neuroma,” Foot and Ankle International, Vol. 29, No. 6, 2008, pp. 578-80. doi:10.3113/FAI.2008.0578
- I. Ducic, A. N. Mesbahi, C. E. Attinger and K. Graw, “The Role of Peripheral Nerve Surgery in the Treatment of Chronic Pain Associated with Amputation Stumps,” Plastics and Reconstructive Surgery, Vol. 121, No. 3, 2008, pp. 908-914. doi:10.1097/01.prs.0000299281.57480.77
- A. L. Dellon, “Treatment of Recurrent Metatarsalgia by Neuroma Resection and Muscle Implantation: Case Report and Proposed Algorithm of Management for Morton’s ‘Neuroma’,” Microsurgery, Vol. 10, No. 3, 1989, pp. 256-259.
- S. L. Shapiro, “Endoscopic Decompression of the Intermetatarsal Nerve for Morton’s Nueroma,” Foot and Ankle Clinics, Vol. 9, No. 2, 2004, pp. 397-407.
- B. R. Vito and L. M. Talarico, “A Modified Technique for Morton’s Neuroma,” Journal of the American Podiatric Medical Association, Vol. 93, No. 3, 2003, pp. 190- 194.
- S. Kinley, S. Frascone, S. Calderone, et al., “Endoscopic Plantar Fasciotomy versus Traditional Heel Spur Surgery: A Prospective Study,” Journal of Foot and Ankle Surgery, Vol. 32, No. 6, 1993, pp. 595-603.
- R. L. Tomczak and B. D. Haverstock, “A Retrospective Comparison of Endoscopic Plantar Fasciotomy to Open Plantar Fasciotomy with Heel Spur Resection for Chronic Plantar Fasciitis/Heel Spur Syndrome,” Journal of Foot and Ankle Surgery, Vol. 34, No. 3, 1995, pp. 305-311. doi:10.1016/S1067-2516(09)80065-3
- C. Villas, B. Florez and M. Alfonso, “Neurectomy versus Neurolysis for Morton’s Neuroma,” Foot and Ankle International, Vol. 29, No. 6, 2008, pp. 578-580. doi:10.3113/FAI.2008.0578
- L. A. Ernberg, R. S. Adler and J. Lane, “Ultrasound in the Detection and Treatment of a Painful Stump Neuroma,” Skeletal Radiology, Vol. 32, No. 5, 2003, pp. 306-309. doi:10.1007/s00256-002-0606-9
- S. Kaminsky, L. Griffin, J. Milsap, et al., “Is Ultrasonography a Reliable Way to Confirm the Diagnosis of Morton’s Neuroma?” Orthopedics, Vol. 20, No. 1, 1997, pp. 37-39.
- F. D. Youngswick, “Intermetatarsal Neuroma,” Clinics in Podiatric Medicine and Surgery, Vol. 11, No. 4, 1994, pp. 579-592.
*Financial Disclosure: Stephen L. Barrett, D.P.M. was a paid medical consultant for Instratek, Inc., which manufactures the EDIN instrumentation. None of the other authors have any financial disclosure.