Factors Associated With Symptom Recurrence After Surgical Treatment of Interdigital Neuroma: A Retrospective Chart Review of 127 Patients

Samir Ghandour; Emi R Suyama; Evan Sirls; Jiyong Ahn; Bernard Burgesson; Soheil Ashkani-Esfahani; Lorena Bejarano-Pineda; Christopher W DiGiovanni

doi:10.5435/JAAOS-D-23-01194

Factors Associated With Symptom Recurrence After Surgical Treatment of Interdigital Neuroma: A Retrospective Chart Review of 127 Patients

J Am Acad Orthop Surg. 2024 May 8. doi: 10.5435/JAAOS-D-23-01194. Online ahead of print.

Authors

Samir Ghandour¹, Emi R Suyama, Evan Sirls, Jiyong Ahn, Bernard Burgesson, Soheil Ashkani-Esfahani, Lorena Bejarano-Pineda, Christopher W DiGiovanni

Affiliation

¹ From the Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA.

PMID: 38723267
DOI: 10.5435/JAAOS-D-23-01194

Abstract

Introduction: Interdigital neuroma (IN) is a benign enlargement of tissue surrounding the common plantar digital nerve. Although the standard surgical treatment of IN remains debated, recent attention has been given to less-invasive surgical decompression by intermetatarsal ligament (IML) release with neurolysis. This study aimed to compare the outcomes of IML release with neurolysis with standard interdigital neurectomy.

Methods: A retrospective chart review was conducted on 350 consecutive patients who underwent surgical treatment of IN. Patients who satisfied our inclusion and exclusion criteria were categorized into two groups based on the surgical treatment received: IML release with neurolysis or interdigital neurectomy. Outcomes assessed included recurrence of symptoms, rate of revision surgery, and postoperative wound infection.

Results: Of the total sample, 40 patients (31.5%) reported recurrence of symptoms within a 12-month follow-up period. Patients who underwent IML release with neurolysis had a markedly higher recurrence rate (47.50%) than those who underwent interdigital neurectomy (24.14%). The rate of postoperative wound infection was similar between the two groups. Binary logistic regression revealed that only the surgical technique was associated with the recurrence of symptoms. Despite the higher rate of symptom recurrence in the IML release with neurolysis patient group, the rate of revision surgery in those with symptom recurrence was similar between both groups.

Discussion: IML release with neurolysis seems to have a higher risk of symptom recurrence than interdigital neurectomy. No patient-specific factors were identified as being associated with symptom recurrence. However, patients who did experience symptom recurrence in either surgical group had similar rates of revision surgery, which may be due to mild recurrent symptom severity in the IML release group that does not warrant revision surgery in these patients. Future studies should consider objective symptom recurrence severity and patient satisfaction.

Level of evidence: Level III.