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 [14]. Further, no other primary nerve entrapment in the human body is treated by open resection [21].

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 [29]. 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.

5. Conclusion

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.

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NOTES

*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.

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