04/06/2021    Don Peacock, DPM

Neuroma Symptoms In the 2nd Innerspace (Burton J. Katzen, DPM)

I agree with Dr. Katzen on the idea of performing a
3rd metatarsal osteotomy for some cases. In my
traditional training I would have disagreed with
him. However having learned MIS, I know the
procedure is valuable. It needs more studies and
scientific backing although literature exists for
the technique.

A helpful technique for me is to not only look at
metatarsal parabola but also use diagnostic
ultrasound. If you look at the forefoot and
determine swelling/edema in the 3rd MPJ, the
anatomy confirms the issue is in the 3rd met and an
osteotomy could be performed or maybe something
even better.

Metatarsal osteotomies only work with percutaneous
procedures. It will lead to abundance of transfer
of pain with open techniques. Thomas Bauer has good
research on the PMO and it has been valuable to me
and my practice.

This all being said, most of these patients have
equinus and this can be addressed via percutaneous
ATL with extremely low complication rates. I would
say that 90% of these patients have equinus and is
the primary deformity. The percutaneous ATL will
make your life immensely simpler than bone work. I
recommend the ATL slide using 2 incisions. You can
find it in the old literature. It's practice
changing is the best and most effective foot
procedure I have ever performed for metatarsal pain
and forefoot ulcers. It corrects the problem
directly with less potential complications.

The procedure is literature proven. Look at Dr.
Monroe LaBorde's work. It's backed by science and I
am so grateful he taught me soft tissue techniques
for metatarsalgia and ulcers. Also, one of the best
foot surgeons who ever lived is Barry Johnson, DPM
a NC practitioner who personally taught me the
percutaneous ATL slide which I have used for years
without even 1 compilation. Not even a heel
transfer ulcer.

I have saved thousands of feet using this technique
for forefoot ulcers. It should be taught as a part
of every surgical residency. It's a sleeper and can
be performed in the office under local anesthetic.
The healing rates for forefoot ulcers and
metatarsalgia is almost too good to be true with
the 2 incision ATL slide.

Don Peacock, DPM, Whitesville, NC

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