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02/13/2025 Allen M. Jacobs, DPM
Would you surgically remove a neuroma without first doing an ultrasound or MRI to confirm? (Eric J. Lullove, DPM)
Dr. Lullove implies that it is near malpractice to remove a suspected interdigital neuroma without confirmation of the diagnosis with preoperative advanced imaging. Simply stated, his position is not only contrary to the standard of care (as reflected in PM News), it is contrary to published studies addressing this issue.
Numerous studies have demonstrated that the accuracy of clinical diagnosis of an interdigital neuroma is sufficient such that advanced imaging is seldom required ( eg: Pastides et al, Foot and Ankle Surgery 18 (1) 2012, Mahadevan et al., JFAS 54 (4), 2015, Owens et al., Foot and Ankle Surgery, 17 (3), 2011.) The clinical diagnosis has been shown to be safe and reliable. Advanced imaging in indicated when the diagnosis is unclear or additional concurrent pathology is suspected.
Dr. Lullove further suggests the possabilty of rare pathology such as malignant or benign neoplastic disorders. Why then would you inject a suspected neuroma without imaging ? Are you not concerned about local trauma and spreading a potential malignancy ?
Furthermore, recent studies suggest that the clinical diagnosis of interdigital neuroma is accurate to a point that the need for pathology examination following excision of an interdigital neuroma in not necessary (eg: O'Connor et al., FAI 37 (1), 2016, Mallina et al., Foot and Ankle Specialist, 10 (6) 2017 ) unless the intra- operative findings are suggestive of an alternate diagnosis.
With regard to advanced imaging, the general trending of the literature is that diagnostic ultrasound is equivalent and more cost effective than MRI for the evaluation of interdigital neuroma.
The position of Dr. Lullove is understandable, however, simply stated it is not the standard of care nor supported by the applicable medical literature. It is the type of thinking and logic which allows plaintiff lawyers to make the hindsight biased arguments they do.
Allen M. Jacobs, DPM, St. Louis, MO
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