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InterdigitalNeuromaG57.60355.6

ICD9 Classification/Treatment

Etiology/NaturalHistory AssociatedInjuries/DifferentialDiagnosis

Anatomy Complications

ClinicalEvaluation FollowupCare

Xray/DiagnositcTests ReviewReferences

synonyms:InterdigitalNeuroma,IDN,Morton'sneuroma

InterdigitalNeuromaICD10

G57.60Lesionofplantarnerve,unspecifiedlowerlimb
G57.61Lesionofplantarnerve,rightlowerlimb
G57.62Lesionofplantarnerve,leftlowerlimb

InterdigitalNeuromaICD9

355.6

InterdigitalNeuromaEtiology/Epidemiology/NaturalHistory

LikelyduetorepetitivetraumafromtransverseintermetatarsalligamentespeciallyinshoesthatcauseMTP
jointextension

InterdigitalNeuromaAnatomy

commondigitalnerveto3rdwebspaceisenlarged.Itisformedfrommergerofmedialbranchoflateral
planternerveandlateralbranchofmedialplanternervejustproxtodeeptransverseligament.Clinical
symptomsofIDNoccurin3rhwebspace80%ofthetime.

InterdigitalNeuromaClinicalEvaluation

Plantarpainthatisrelievedbyrestisthemostconsistentfindinginapproximately90%ofpatientswith
Morton'sneuroma.SwellingisnotnormallyassociatedwithMorton'sneuroma.Numbnessintothetoesis
reportedinapproximately40%ofpatients.Mulder'sclickisafrequentfinding,butisnotconsistently
associatedwiththepresenceofaneuroma.Approximately3%ofpatientswithaneuromashowwideningof
thetoeinterspace
mostcommonlyfemale8/1

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patestehsia,dysesthesiausally3rd&4thtoes,oftenvague,diffusediscomfortinforefoot,midfootandlower
leg.Ptsoftendescribepainasdorsal

InterdigitalNeuromaXray/DiagnosticTests

InterdigitalNeuromaTreatment

Nonop=widetoeboxshoewithafirmsole,metatarsalpadinsideshoeorbaronsoleofshoe,steroidinjection
Operative=resectionofneuroma23cmproximaltodeeptransverseintermetatarsalligamentthroughadorsal
incision.85%goodtoexcellentresults
CPT28080excisioninterdigitalneuroma(Morton'sneuroma)
15%surgicalfailureratemaybeduetoincorrectdiagnosis,improperwebspaceselection,orstumpneuroma
formation.

InterdigitalNeuromaTechnique

Calftourniquet.
Dorsallongitudinalincisionfromthewebspaceextendingproximally23cm.
Fasciareleasedovertheintermetatarsalligament
Intermetatarsalligamenttransectedwithafreerelevatorplacedunderneaththeligamenttoprotectthe
underylingstructures
Dorsallydirectedpressureundertheareaaidsexposureoftheneuroma
Finerightanglehemostatwasutilizedtofreethenerveandexposethebifucation.
Properdigitalnerveswerethentransected.
gentlepressurewasplacedonthepropernerveandthenervewasthentransectedproximally
Specimenwassentforhistologicexamination.
Areawascopiouslyirrigated.
Tourniquetreleased,hemostasisobtained
Closure

InterdigitalNeuromaDifferentialDiagnosis

tarsaltunnelsyndrome

InterdigitalNeuromaComplications

Recurrentneuroma>>mostwillfindreliefwithconservativetreatmentrx=operativerevisionofnervetoamore
proximalleveloffweightbearingarea(6575%successful).(JohnsonJBJS198870A:651).

InterdigitalNeuromaFollowupCare

InterdigitalNeuromaReviewReferences

1.Beskin,JAAOS5:2611997
2.BennettGL,GrahamCE,MauldinDM:Morton'sinterdigitalneuroma:Acomprehensivetreatmentprotocol.
FootAnkleInt199516:760763
3.WeinfeldSB,MyersonMS:Interdigitalneuritis:Diagnosisandtreatment.JAmAcadOrthopSurg
19964:330335

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