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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