Neuroma surgery is the removal of damaged nerves in the ball of the foot. Neuroma is a condition that causes inflammation and pain on the nerves located between the toes, on the bottom of the forefoot, and numbness of the toes especially when walking barefoot.
Causes for Neuroma
Causes of neuroma include:
- Improper footwear such as pointed high heels
- Genetic factors
- Pressure applied on the ball of the foot as a result of being overweight
- Laxity of the connective tissue of the tight calf muscle
- Pressure on the nerves caused by thinning of the fat pad on the ball of the foot
The Need for Neuroma Surgery
The common indications that would lead to neuroma surgery include:
- Difficulty in fitting footwear
- Interference on mobility
- Swelling of the foot or toes
- Dysesthesia; abnormal sensation that is caused by prickling or having a burning sensation in the feet or legs
- Hypesthesia – Diminished sensation of the skin on the feet or toes
Techniques Involved in Neuroma Surgery
The technique used in neuroma surgery depends on if there is a distal nerve end or none. When there is a terminal nerve that is intact, neuroma reconstruction by hollow tube or allograft nerve reconstruction is done. When there is no distal end, reconstruction is done by using nerve cap, relocation of the nerve grafting, excision and implantation among other treatment options are considered. Factors such as the stump end or continuity of the neuroma determine how the reconstruction will be performed.
Available Distal Nerve End
Hollow tube construction: This is used for short hollow nerve gaps to revive the function of the nerve and reduce pain. Hollow tube reconstruction is however efficient in repairing longer defects.
Allograft or autograft: Sensory nerve neuroma that requires nerve grafting is reconstructed by allograft or autograft to cover the nerve gap, and reduce pain and numbness.
Unavailable Distal Nerve End
Excision and implantation of the proximal with the distal nerve stump is done by concealing the nerve ends deeper within the tissues to protect the nerve. The nerve is inserted inside the veins, muscles or bone to generate growth.
Nerve cap is placed at the terminal end of the nerve to improve the regrowth of the nerve end that is painful.
Centro-central connector assisted neurorrhaphy: This is the controlling of the growth of the terminal end by stitching a divided nerve by using nerve graft of a hollow tube repair.
Relocation of nerve grafting: This is a technique performed to give a pathway for the nerve allowing fiber nerves (axons) to grow by using allograft.
End to side repair which is used to provide a passage for restoration fiber nerve to prevent recurrence of the painful neuroma.
RPNI: Known as Regenerative Peripheral Nerve Interface, this is a surgical procedure which involves inserting the divided end of the peripheral nerve into a free muscle by wrapping it around the terminal nerve stump. This enhances the production of nerves and reducing the neuroma pain.
Targeted muscle reinnervation: This is used to enhance a prosthesis that is myoelectric. The peripheral nerves that have blind ends are fastened together to allow restoration of the surgical graft or supply of nerves to a certain part of the body that has lost the nerve.
After the neuroma surgery, an orthopedic footwear is given to protect the foot from any injury. Resting of the foot is recommended in order to avoid any weight bearing within the first week post operation. This is for relieving the pain and increase blood flow. However slow movements are encouraged in order to avoid occurrence of blood clots.
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