COPYRIGHT 2001 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED

Operative Treatment
of Interdigital Neuroma
A LONG-TERM FOLLOW-UP STUDY
BY MICHAEL J. COUGHLIN, MD, AND TROY PINSONNEAULT, MD
Investigation performed at St. Alphonsus Regional Medical Center, Boise, Idaho

Background: The literature regarding the outcome of surgical treatment of interdigital neuroma is incomplete. The
purpose of this study was to assess the demographics associated with the presentation of an interdigital neu-
roma as well as the long-term clinical results of operative resection by a single surgeon.
Methods: A retrospective review of the patient records of one orthopaedic foot and ankle surgeon identified
eighty-two patients who had been treated operatively for a primary, persistently painful interdigital neuroma more
than three years previously. Of these eighty-two patients, sixty-six (seventy-one feet, seventy-four neuromas) re-
turned at an average of 5.8 years for a follow-up evaluation, which included a review of the interval history since
the surgery, a physical examination, a radiographic evaluation, and an assessment of the patients satisfaction
with the result of the surgery.
Results: Overall satisfaction was rated as excellent or good by fifty-six (85%) of the sixty-six patients. Forty-six
(65%) of the seventy-one feet were pain-free at the time of final follow-up. The patients who had had either bilat-
eral neuroma excision or excisions of adjacent neuromas in the same foot in a staged fashion had a slightly lower
level of satisfaction, but this difference was not significant. While major activity restrictions following surgery were
uncommon, mild or major shoe-wear restrictions were noted by forty-six of the sixty-six patients. Although there
was subjective numbness in thirty-six of the seventy-one feet, the pattern of numbness was quite variable and it
was bothersome in only four feet.
Conclusion: With careful preoperative evaluation and patient selection, resection of a symptomatic interdigital
neuroma through a dorsal approach can result in a high percentage of successful results more than five years fol-
lowing the procedure.

T
he clinical symptoms associated with an interdigital
neuroma were initially reported by Civinni in 18351
and later by Durlacher in 18452. Although Morton3
mistakenly attributed this condition to an affection of the
fourth metatarsophalangeal joint, his name, nonetheless,
is most commonly associated with the lesion. Perineural
fibrosis has been documented on histological evaluation of
surgical specimens4-24. This finding has led many investi-
gators to propose a symptomatic entrapment neuropathy
of the interdigital nerve at the distal extent of the trans-
verse intermetatarsal ligament as the cause of an interdigi-
tal neuroma4,8,10,13,14,17,19,25-29.
The demographics of interdigital neuromas have been
well documented; they include a higher prevalence in wo-
men11,15,23,24,26,28,30-34, a mean age at onset in the fifth de-
cade15,16,23,24,31,32,35,36, the most common location in the third in-
termetatarsal space4,5,8,20,23,26,31,37, and exacerbation of symptoms
with constricting shoe-wear4,5,9,15,16,34,38-41. Although several au-
thors have reported a high rate of satisfactory postoperative
results4,8,11,15,24,26,34,36,41, many reports are characterized by short-
term follow-up18,26,33,34,42 and a lack of postoperative clinical
evaluation11,12,31,33,36,43,44. Other confounding factors in published
reports on the operative treatment of neuromas include the
involvement of multiple surgeons35, simultaneous surgery in
an adjacent web space11,23,31,35,43, and the inclusion of patients
with both primary and recurrent neuromas15,31,35, making the
evaluation of success rates following primary neuroma exci-
sion difficult to assess. Confounding diagnoses such as inflam-
matory and degenerative arthritis as well as instability of a
lesser metatarsophalangeal joint require preoperative radio-
graphic assessment, which has previously been documented in
only one study 35.
The purpose of the present study was to document the
long-term clinical results of surgical excisions of primary in-
terdigital neuromas performed by a single surgeon.
Materials and Methods
Demographics
From January 1991 to January 1997, 121 consecutive patients
(131 feet, 136 neuromas) underwent surgical excision of a
persistently symptomatic interdigital neuroma by the senior
author (M.J.C.). Their records were retrospectively reviewed,

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and thirty-nine patients (forty-two feet, forty-four neuro-
mas) were excluded. The reasons for exclusion were death
(two patients), a diagnosis of inflammatory arthritis (two pa-
tients), a diagnosis of recurrent neuroma following failed
prior surgery (eleven patients), and a diagnosis of concomitant
instability of a lesser metatarsophalangeal joint (twenty-four
patients). A diagnosis of instability of a lesser metatarsopha-
langeal joint required radiographic demonstration of medial
deviation of the second or third metatarsophalangeal joint of
>544 with concurrent pain on palpation of the plantar aspect
of the second or third metatarsophalangeal joint44-46, a positive
drawer sign47, and relief of pain following an intra-articular
injection of lidocaine hydrochloride48. Of the remaining
eighty-two patients who had undergone excision of an inter-
digital neuroma, sixty-six (81%) (seventy-one feet, seventy-
four neuromas) were successfully contacted and returned for
examination by another orthopaedic surgeon (T.P.). All of the
patients records, including preoperative and postoperative
chart notes and radiographs, operative reports, and pathol-
ogy reports, were reviewed.
During the study period, fifty-eight patients had uni-
lateral neuroma excision, five patients had bilateral neu-
roma excision, and three patients had neuromas in adjacent
intermetatarsal spaces in the same foot excised at different
times (with nine to twenty-six months between the initial
and second resections) by the senior author; thus, there was
a total of seventy-four neuroma excisions in seventy-one
feet. In addition to the five patients who had a neuroma on
each foot excised within the time-frame of this study, nine
patients had a neuroma excised from the contralateral foot
not within the time-frame of this study (one to sixteen years
[average, nine years] before or after the study). Also, in addi-
tion to the three patients who had adjacent excisions per-
formed by the senior author during the study period, one
patient had an adjacent neuroma excised by another surgeon
twelve months prior to the index procedure, one had an ad-
jacent neuroma excised by another surgeon twelve months
after the index neuroma excision, and one patient had an ad-
Fig. 1
The Mulder sign. The forefoot is grasped with one hand to
compress the transverse metatarsal arch. The symptomatic
interspace is squeezed between the index finger and the
thumb of the other hand. A palpable click (a positive Mulder
sign) is thought to be caused by the enlarged interdigital
nerve as it moves beneath the transverse intermetatarsal
ligament.
O P E R A T I VE TRE A T M E N T O F
I N T E R D I G I T A L N E U RO M A
jacent neuroma excised by the senior author two years fol-
lowing the conclusion of this study.
Preoperative Findings
The indication for surgery was intractable pain isolated to
either the second or the third intermetatarsal space that was
refractory to conservative treatment such as the use of orthotic
devices, metatarsal pads, nonsteroidal anti-inflammatory
medications, or shoe-wear modification; this was present in
all seventy-four cases. The magnitude of the preoperative
pain, however, was not quantitated. A vague description of
ill-defined pain in the forefoot was typical at the initial eval-
uation, following which the patients were requested to exac-
erbate the symptoms with the use of constricting shoe-wear
and increased physical activity in an attempt to help them
to isolate the pain to a discrete area. If at repeat evaluation
the exact location of the pain remained unclear, 1% lido-
caine hydrochloride was injected into the most symptom-
atic interspace in an attempt to temporarily alleviate the
symptoms. The temporary relief of symptoms following an
injection was correlated with the history and the findings
on physical examination to localize the painful interspace.
Diagnostic injections were used in forty-four (59%) of the
seventy-four cases to assist in determining the location of
the neuroma. The number of visits prior to the surgery av-
eraged 2.1 (range, one to four). Metatarsal pads or orthotic
devices were used preoperatively by twenty-six (39%) of
the sixty-six patients. Radiation of neuritic pain (twenty-
six [35%] of the seventy-four cases), numbness of an adja-
cent digit (twenty-two [30%]), and a positive Mulder sign49
(Fig. 1) (thirty [(41%]) were found on preoperative physi-
cal examination.
Follow-up Evaluation
The average duration of postoperative follow-up was sixty-
nine months (range, thirty-eight to 121 months). At the
time of final follow-up, patients were asked to characterize
the pain as none, mild, moderate, or severe. They were also

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asked to characterize their footwear restrictions as none
(can wear any style of footwear at any time), mild (unable to
wear narrow shoes or high heels but able to wear all other
types of shoes), or major (difficulty in finding comfortable
shoes). In addition, they were asked to characterize activity
restrictions as none (no restrictions, with the ability to par-
ticipate in any sports or recreational activities), mild (mild
restrictions, but not enough to interfere with everyday ac-
tivities), or major (severe restrictions, with an inability to
perform daily activities or work). Patients were asked to rate
their overall satisfaction with the result of the surgery as ex-
cellent, good, fair, or poor according to our previously pub-
lished scale50. With this scale, patients rate the result as
excellent if they have no problems related to the foot, are
very satisfied, have mild or no pain, and walk without diffi-
culty; as good if they have few problems, are satisfied, have
mild pain, walk without difficulty or with mild difficulty,
and would have the surgery again under similar circum-
stances; as fair if they have moderate pain, some difficulty
walking, and reservations about the success of the surgery;
and as poor if they have continued pain, have little improve-
ment in walking, and regret having had the surgery.
At the time of final follow-up, the physical examination
included inspection and palpation of the foot with attention
to any sensory deficits (on light touch with pinprick), the
presence of intractable plantar keratoses, fat-pad atrophy, in-
cisional pain, and interspace or metatarsophalangeal joint ten-
derness. A positive percussion test of the involved nerve, the
presence of a Mulder sign49 (Fig. 1), and the presence of insta-
bility of a lesser metatarsophalangeal joint (a drawer sign46-48)
(Fig. 2) were evaluated as well.
Radiographic Evaluation
Preoperative weight-bearing radiographs were reviewed and
compared with standardized postoperative weight-bearing ra-
diographs at the time of final follow-up. These radiographs
were inspected for evidence of degenerative or inflammatory
arthritis as well as for evidence of malalignment associated
with instability of a lesser metatarsophalangeal joint as de-
fined above.
O P E R A T I VE TRE A T M E N T O F
I N T E R D I G I T A L N E U RO M A
Fig. 2
The drawer sign. With the symptomatic digit grasped between the
thumb and the index finger, the toe is subluxated in a dorsal direction.
With instability, pain is elicited at the symptomatic metatarsopha-
langeal joint.
Surgical Technique
All operations were performed, with use of a standard tech-
nique, by the senior author (M.J.C.). Under tourniquet con-
trol, a 3-cm dorsal longitudinal incision is centered over the
involved interspace. The transverse intermetatarsal ligament is
placed under tension with a self-retaining retractor and is di-
vided. A small periosteal elevator is then used to delineate the
involved nerve both proximally and distally. The digital nerves
distal to the bifurcation of the common digital nerve are
transected. The dissection is then carried proximally into the
interspace, isolating the common digital nerve approximately
3 cm proximal to the bifurcation, where it is transected. (As
described by Mann and Reynolds15 and by others24,51, it is im-
portant to sever any adjacent capsular nerve branches at this
time as they may prevent proximal migration of the nerve
stump, increasing the possibility of a recurrent symptomatic
neuroma.)
The patient is allowed to walk wearing a postoperative
shoe with full weight-bearing, as pain permits, immediately
following the surgery.
All statistical analyses were performed with use of Mi-
crosoft Excel (Redmond, Washington). A chi-square test was
used to compare levels of postoperative subjective satisfac-
tion. The comparisons of postoperative satisfaction follow-
ing bilateral surgery and that following surgery in adjacent
interspaces were performed with use of a Fisher exact test (a
variation of the chi-square test) because one of the cell sizes
was quite small.
Results
ifty-two (79%) of the sixty-six patients were female, and
F fourteen (21%) were male. The average age at surgery was
fifty years (range, fifteen to seventy-seven years). Thirty-five
neuromas occurred in the right foot and thirty-nine, in the
left. Sixteen (22%) of the seventy-four neuromas occurred in
the second intermetatarsal space, and fifty-eight (78%) oc-
curred in the third intermetatarsal space (ratio, 1:3.6).
Overall satisfaction was rated as excellent by forty pa-
tients (61%), good by sixteen (24%), fair by five (8%), and
poor by five. At the time of final follow-up, thirteen feet

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were mildly painful, nine were moderately painful, and three
were severely painful; the remaining forty-six feet (65%) were
pain-free. A peripheral neuropathy later developed in one of
the ten patients who had an overall satisfaction rating of fair
or poor, a peripheral nerve injury developed following re-
gional anesthesia in another, a reflex sympathetic dystrophy
developed in one, and severe instability of the second meta-
tarsophalangeal joint developed in one. Of the five feet that
were subjectively rated as poor, four were noted to have
moderate or severe pain localized to the area of the neu-
roma resection. The fifth patient who rated the result as
poor was dissatisfied because of persistent numbness of the
lesser toes.
Of the fourteen patients who underwent bilateral neu-
roma excision (either simultaneously or on a delayed basis),
eleven had a satisfaction rating of good or excellent. Of the six
patients who had adjacent neuroma excisions, with one proce-
dure performed either prior to or as a delayed procedure after
the other, four reported an excellent or good result and two
noted a fair or poor result. With the numbers available, the
proportion of patients with an excellent or good result was
statistically the same whether a unilateral, bilateral, or adja-
cent neurectomy had been performed (bilateral compared
with unilateral procedures, p = 0.69; adjacent compared with
unilateral procedures, p = 0.40).
One deep wound infection was treated with incision,
drainage, and open packing, and it went on to heal success-
fully; at the time of final follow-up, the patient had an excel-
lent result. Minor wound complications characterized by
persistent erythema or serous drainage lasting for longer than
ten days developed in six patients. These patients were treated
Fig. 3
Areas of numbness following neuroma resection. Numbness was found to be localized to three areas: between the digits, on the plantar aspect of
the web space, and at the terminal aspects of the digits, with some overlap between areas.
O P E R A T I VE TRE A T M E N T O F
I N T E R D I G I T A L N E U RO M A
with oral antibiotics, and all wounds healed successfully. Of
these six patients, three rated the result as excellent; two, as
good; and one, as poor. Four of the seventy-one feet under-
went subsequent surgery; a neurectomy in the adjacent inter-
space was done in two, and other, unrelated surgery was done
in two. The site where the interdigital neuroma had been ex-
cised was not reexplored in any foot.
Tenderness on palpation in the surgically treated in-
terspace was noted at the time of final follow-up in forty-five
(61%) of the seventy-four cases, although patients infre-
quently complained or were aware of pain in this region.
There was tenderness on direct palpation of the plantar as-
pect of seven lesser metatarsophalangeal joints. Three of
these feet were rated as poor; one, as fair; two, as good; and
one, as excellent. A positive drawer sign that had not been
present preoperatively was observed in eleven lesser meta-
tarsophalangeal joints postoperatively. Of these joints, five
appeared normal radiographically and only two had a com-
bination of tenderness on palpation, a positive drawer sign,
and radiographic evidence of instability. These two lesser
metatarsophalangeal joints were in two patients who com-
plained of pain and rated the result as poor. A positive
Mulder sign, present in thirty of the seventy-four cases pre-
operatively, was absent in all but two of the thirty cases post-
operatively. The result in both cases was rated as excellent at
the time of final follow-up.
There was a discrepancy between the subjective sensa-
tion of numbness and the result of the sensory examination at
the time of final follow-up. Upon questioning, patients re-
ported numbness in thirty-six (51%) of the seventy-one feet,
but the numbness was considered bothersome in only four

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feet. In contrast, the objective findings included normal sensa-
tion in two (3%) of the seventy-one feet, numbness between
the digits in fifty-one (72%), numbness in the plantar web
space in forty-six (65%), and numbness in the terminal aspect
of the digits in twenty-nine (41%). Several patients had more
than one area of numbness (Fig. 3). A positive nerve percus-
sion test (Tinel sign) was noted in one dorsal incision, in a
patient who rated the result of the surgery as excellent. All
other incisions were well healed and asymptomatic. A posi-
tive nerve percussion test was observed in twenty-six (35%) of
the seventy-four involved interspaces at the final examina-
tion, although prior to that time none of the patients were
aware of this finding and it was not mentioned as a subjective
complaint.
A discrete intractable plantar keratosis developed be-
neath a lesser metatarsal head in eleven of the seventy-one
feet, although there was clinical and radiographic evidence
of instability of the metatarsophalangeal joint in only one of
them. The result was rated as good or excellent in nine of
these eleven feet and as poor in two at the time of final
follow-up. Diffuse fat-pad atrophy developed following the
surgery in two other patients, yet both rated the final result
as good.
Twenty (30%) of the sixty-six patients reported no
shoe-wear restrictions, and thirty-five reported mild restric-
tions. Of eleven patients with major shoe-wear restrictions,
five reported continued pain related to the neuroma surgery
and the other six had problems unrelated to the neuroma
surgery. Postoperatively, twenty-three (35%) of the sixty-six
patients used metatarsal pads or orthotic devices although
fourteen had not used them before surgery. Fifteen of those
who had used orthotic devices or metatarsal pads prior to
surgery discontinued their use after surgery. Forty-one
(62%) of the sixty-six patients stated that they had no activ-
ity restrictions at the time of long-term follow-up, whereas
twenty-three had mild restrictions and two had major
restrictions.
At the time of surgery, seventy-two of the seventy-four
specimens were submitted for histologic examination. All sev-
enty-two specimens were reported by the pathologist to be
consistent with an interdigital neuroma.
Comparison of the preoperative and postoperative
weight-bearing anteroposterior radiographs demonstrated that
moderate or severe malalignment of a lesser metatarsopha-
langeal joint had developed in six feet. An asymptomatic posi-
tive drawer sign had also developed in three of these six feet.
All of these patients had had a negative response to an intra-
articular injection of lidocaine and a negative drawer test
preoperatively. Pain did not develop in the second metatar-
sophalangeal joint in any of the six feet. Of these six feet, four
were subjectively rated as excellent and two, as good at the
time of final follow-up.
Discussion
o the best of our knowledge, this investigation represents
T the longest reported follow-up in a series of primary re-
O P E R A T I VE TRE A T M E N T O F
I N T E R D I G I T A L N E U RO M A
sections of interdigital neuromas. The term metatarsalgia is
commonly used to describe ill-defined forefoot pain, for
which a neuroma is only one of several possible causes. It can
be a diagnostic challenge to differentiate other conditions
such as inflammatory or degenerative arthritis, a metatarsal
stress fracture, and instability of a lesser metatarsophalan-
geal joint52.
Location of Pain Preoperatively
In this series, fifty-six (85%) of sixty-six patients reported a
good or excellent result. We believe that the key to this high
level of satisfactory results was the careful preoperative clini-
cal evaluation in which other, confounding diagnoses were
eliminated. Exact localization of pain can be assisted with
the use of sequential injections of a small volume (about 1
ml) of 1% lidocaine hydrochloride in the intermetatarsal
space and later in the adjacent metatarsophalangeal joints.
This test was useful in forty-four (59%) of seventy-four
cases. A patient can compare the relief obtained with each
separate injection to better define the area of pain. With a
larger volume of lidocaine, a larger area may become numb,
leading to an incorrect diagnosis. The use of sequential in-
jections is only one part of the diagnostic process, which re-
quires correlation with the history as well as clinical and
radiographic evaluations. In 41% of the cases, there was no
need for an injection because the patient was able to discern
the specific area of discomfort. The low rate of later re-
exploration of adjacent intermetatarsal spaces (two of the
seventy-one cases) and the fact that no surgically treated in-
terspace was reexplored following the index surgery support
our premise that careful repetitive evaluation combined with
diagnostic injections is useful in assisting patients who have
difficulty in finding the exact area of pain.
Preoperative Radiographic Examination
The preoperative radiographic examination also helped us
to identify patients with forefoot pain that was not due to a
neuroma. Twenty-four patients with radiographic evidence
of instability of a lesser metatarsophalangeal joint as well as
physical evidence of the instability (a positive drawer sign
and metatarsophalangeal joint pain) were eliminated from
this series preoperatively in spite of the fact that they also
had symptoms of an interdigital neuroma. These patients
underwent both reconstruction of the second metatar-
sophalangeal joint and neuroma excision; a future report
will document the surgical technique and clinical course of
these patients53.
Preoperative Physical Examination
Mulder49 and others8,16 have reported a palpable click with
compression of the involved interspace between the exam-
iners index finger and thumb as the transverse arch is com-
pressed. While it may be hypothesized that the thickened
interdigital nerve subluxates beneath the adjacent metatarsal
heads and the intermetatarsal ligament with this maneuver,
the anatomical basis of this sign has never been substantiated.

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Nonetheless, surgery successfully eliminated this finding in
twenty-eight of thirty cases.
Postoperative Findings
Scar Sensitivity
At the time of final follow-up, sensitivity at the site of the
nerve transection was still present in more than one-third of
the cases, although no patient was aware of this finding until
he or she was examined. Patients should be counseled that the
nerve transection leaves a discrete area of tenderness that fre-
quently remains but that retraction of the cut nerve should re-
sult in minimal if any symptoms.
Residual Pain and Tenderness
It is not uncommon for a patient to have residual pain in ei-
ther the involved interspace or an adjacent lesser metatar-
sophalangeal joint following neuroma surgery and yet still
have a satisfactory result. Interspace tenderness was a fre-
quent finding on physical examination (forty-five [61%] of
the seventy-four cases), but it was rarely recognized by pa-
tients prior to the final follow-up examination and there was
persistent interspace pain related to the neuroma surgery in
only six of the forty-five cases. (Five were rated as having a
poor result.)
Problems Related to the Lesser
Metatarsophalangeal Joint
There was no preoperative instability of a lesser metatar-
sophalangeal joint in any of the seventy-four cases in this
series. At the time of final follow-up, a single lesser metatar-
sophalangeal joint was demonstrated to have a positive
drawer sign in eleven feet but only six were noted to be pain-
ful with this maneuver. We are not sure of the clinical rele-
vance of instability of a lesser metatarsophalangeal joint in
relation to a previous neuroma excision; however, the insta-
bility was not necessarily associated with metatarsophalan-
geal joint pain or abnormal radiographic findings. Karges33
reported tenderness of a lesser metatarsophalangeal joint
following neuroma surgery in fifteen of thirty-five feet seen at
the time of follow-up. In the current series, seven of seventy-
four adjacent lesser metatarsophalangeal joints were tender.
Also, an intractable plantar keratosis developed beneath an
adjacent lesser metatarsal head postoperatively in eleven (15%)
of seventy-one feet. Karges noted that, in thirteen (23%) of
fifty-seven cases, an intractable keratotic lesion developed
following surgery. Patients should be alerted to the possibil-
ity of the development of an intractable plantar keratosis fol-
lowing excision of an interdigital neuroma, but symptoms
are seldom severe.
Sensory Deficit
The magnitude of the postoperative sensory deficit has been
assessed in very few studies15,35,43. Mann and Reynolds15 ob-
served that there is substantial variability in the cutaneous in-
nervation of both the web space and the plantar aspect of the
foot adjacent to the web space. Previous investigators have
O P E R A T I VE TRE A T M E N T O F
I N T E R D I G I T A L N E U RO M A
noted normal sensation after neuroma excision in a relatively
high percentage of patients (range, 29%35 to 34%15). In the
current series, subjective numbness was observed in thirty-six
(51%) of seventy-one feet, but it varied considerably from
patient to patient. It was bothersome in only four of the
seventy-one feet. All six patients who had neuromas excised
from adjacent web spaces described wide areas of numbness
involving the plantar aspect of the web space, the tips of the
toes, and the area between the toes, confirming the obser-
vation of Benedetti et al.43 that excision of adjacent common
digital nerves leaves a substantial neurologic deficit. Patients
should be counseled preoperatively that postoperative numb-
ness of a varying degree is commonly associated with resec-
tion of an interdigital neuroma.
Shoe-Wear and Activity Limitations
Shoe-wear8,15,31,33 and activity limitations8 have previously
been reported following neuroma resection. In the current
series, 70% of the patients had mild or major shoe-wear re-
strictions and 38% had mild or major activity restrictions.
Patients should be advised that shoe-wear restrictions are
likely following surgery but that major activity limitations
are uncommon.
Surgical Approach
While both a dorsal4,8,9,15,23,26,32,54 and a plantar approach5,12,13,16,
23,30,33,49,55-57
have been recommended for the resection of an in-
terdigital neuroma, the senior author has preferred a dorsal
incision because of the low prevalence of wound compli-
cations and the increased ability of patients to bear weight
immediately postoperatively. The minimal rate of wound
complications (two [3%] of seventy-four incisions) reported
in the present series is distinctly lower than the complication
rates following a plantar approach, which have ranged from
10%33 to 36%24.
The excisions of neuromas from adjacent interspaces
were never performed simultaneously in the current series.
Indeed, adjacent neuromas are uncommon23,28,31,37,43, and
careful preoperative evaluation should enable one to localize
the problem to a single interspace. Friscia et al.31 reported that
simultaneous adjacent web-space exploration, in nine cases,
was associated with a much higher dissatisfaction rate. In
our six patients in whom adjacent neurectomies were done
in a staged fashion, a more extensive area of numbness per-
sisted in the foot and the satisfaction rate was somewhat
lower.
While Greenfield et al.32 concluded that early excellent
results often deteriorate with time after excision of an inter-
digital neuroma, we observed a high level of continued satis-
faction after an average duration of follow-up of sixty-nine
months. Residual pain in either an involved interspace or an
adjacent metatarsophalangeal joint, sensitivity at the level of
the nerve transection, and variable areas of numbness are
common findings following resection of an interdigital neu-
roma, but they frequently are not recognized by patients and
rarely require treatment.


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Michael J. Coughlin, MD
901 North Curtis Road, Suite 503, Boise, ID 83706. E-mail address:
footmd@aol.com
Troy Pinsonneault, MD
Edmonton, AB, Canada
References
1. Civinni F. Su di un gangliare rigonfiamento della piata del piede. Mem Chir
Archiespedale Pistoia. 1835:4-17.
2. Durlacher L. A treatise on corns, bunions, the disease of nails, and the general
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The authors did not receive grants or outside funding in support of their
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ments or other benefits or a commitment or agreement to provide such
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