Symptomatic Incisional Neuromas on the Dorsum of the Foot

Abstract

In a 2-year period, 17 patients presented with 25 highly symptomatic neuromas which followed routine orthopaedic procedures on the dorsum of the foot. Most of the neuromas followed incisions made on the dorsomedial two-thirds or so of the midfoot. Three of the patients who refused surgery and were treated nonoperatively had mediocre results. Fourteen patients underwent surgery. Two early cases underwent neurolysis of spindle neuromas with satisfactory results but with some persistent pain and dysfunction. Spindle and bulb neuromas in the remaining 12 patients were widely excised with highly satisfactory results in 10 and unsatisfactory results in two. A functional anatomic study was carried out to determine the area of sensation supplied by the deep peroneal nerve. The results of this study along with a review of anatomical references was used to diagram the sensory distribution to the dorsum of the foot. These diagrams proved helpful in making accurate anatomic diagnoses of the nerves involved with neuromas prior to treatment. The incidence of incisional neuromas is higher than anticipated, and the disability from them can be as severe as those reported in the hand and wrist. Proper diagnosis and treatment are essential to relieve this disability.