MORTON'S NEUROMA
New Surgical Treatment for Morton's Neuroma: Minimally Invasive Nerve Decompression (MIND)
Morton's neuroma is a painful forefoot condition affecting thousands of patients every year. It is a tumor-like mass of neurilemmal cells surrounding the common digital nerve found in the third intermetatarsal space. This nerve branches into proper digital nerves, providing sensation for adjacent sides of the third and fourth toes. The nerve passes plantarly to the transverse intermetatarsal ligament while it branches to enter the toes.
Histological findings suggest that the process of Morton's nerve is degenerative, caused by repetitive trauma and entrapment secondary to pressure from the transverse ligament. Following failed conservative treatment, surgical options include: complete neurectomy of the neuroma or decompression. Recent studies have shown significantly higher success rates with surgical decompression vs. neurectomy.The new (MIND) procedure utilizies the Isogard System. It contains four instruments designed to allow the procedure to be performed through a single small incision in the interdigital web-space. These include:
A tissue locator
A ligament separator
The Isogard instrument
A single use blade
Externally, manipulation of the metatarsal heads is used to determine tightness of the intermetatarsal ligament, pre- and post-operatively. A 7.0 mm vertical incision is made in the web-space. Deep probing is performed to prepare soft tissue channels above and below the ligament. The Isogard instrument is then inserted to capture the ligament and the surgical blade advances through the interior channel to cut the ligament from distal to proximal. The incision can be closed with one or two simple interrupted sutures. Adequate post-op care normally allows patients to return to comfortable shoes within one week.
A recent study indicated 95.2% of patients undergoing the MIND procedure either had the symptom completely relieved or were improved.
CONDITIONS
