|
|
|
Search
03/23/2021 Samuel Cox, DPM
FL Podiatrist Discusses Morton's Neuroma (Peter J. Bregman, DPM)
I read the response from Peter J. Bregman, DPM and agree I would love to never do another neurectomy. That said, I have tried first cutting the deep transverse ligament (DTL) with an #18 needle with poor success. Then I went to an MIS technique of using a #67 or #64 blade and hugging the metatarsal and cutting the ligament with only slightly better success. More recently, I have been doing about a 1.5 cm incision, then using a freer elevator to locate the DTL. I then use a tenotomy scissor to cut the ligament, and use a hemostat to spread the interspace, with better success.
With this type of procedure, there is very little post-op pain and no bleeding. I use a few simple sutures and it is quickly done, however there have been some of those procedures that have failed as well. All the prior listed procedures were done in the office. If I go to the hospital or SC for a most open traditional neurectomy, I often find that there are some very deep binding fibers well under the level of the DTL. I truly believe if I released those fibers, the patient’s issues and pain would be resolved. However, because a decompression in-office had already failed and the patient was booked for a neurectomy, if I leave the nerve in the foot at that point and they don’t have a good result, then I could be in a pickle from a medical legal standpoint.
This is even more so than if the patient developed a stump neuroma because that is a known complication. The real issue is figuring out how to release those deep fibers, saving the nerve, and not causing a bleeding problem while doing an in-office procedure. This is because the reimbursement for the open surgery is so low for the time commitment to be done in a hospital or surgery center that I need to either not do them at all or find a way to do them in-office with greater success. Now there is an MIS procedure that can be done in the office where you release the DTL and do metatarsal osteotomies to both adjacent metatarsals with some anecdotal success. I have not attempted this technique as yet. Comments? Samuel Cox, DPM, Goodyear, AZ
There are no more messages in this thread.
|
|
|
|