Name of the Procedure:

Excision of Neuroma; Hand or Foot, Except Digital Nerve

• Common Names: Neuroma Removal, Morton’s Neuroma Surgery (for foot), Intermetatarsal Neuroma Excision

Summary

Excision of a neuroma involves the surgical removal of a painful and enlarged nerve, typically in the hand or foot. This procedure is often performed to alleviate chronic discomfort or pain that does not respond to conservative treatment.

Purpose

This procedure addresses conditions involving irritated or swollen nerves, often due to compression or injury. The goal is to relieve pain, restore function, and improve the patient's quality of life by removing the affected nerve tissue.

Indications

• Chronic pain or burning sensation in the hand or foot
• Numbness or tingling in fingers or toes
• Difficulty walking or maintaining grip strength due to pain
• Failure of conservative treatments such as physical therapy, orthotics, anti-inflammatory medications, or corticosteroid injections

Preparation

• Patients may be instructed to fast for several hours prior to surgery.
• Medications affecting blood clotting or anesthesia may need adjustment.
• Preoperative assessments, including imaging studies like MRI or ultrasound, may be conducted to confirm the diagnosis and plan the surgery.

Procedure Description

1. Anesthesia: Local or regional anesthesia is typically used to numb the area; sedation may be provided.
2. Incision: A small incision is made over the site of the neuroma.
3. Exposure: The surrounding tissues are gently separated to expose the affected nerve.
4. Excision: The neuroma is identified, carefully isolated, and removed.
5. Closure: The incision is closed with sutures and a sterile dressing is applied.

Tools and Equipment:

• Surgical scalpel
• Small retractors
• Microsurgical instruments
• Sutures and dressings

Duration

The procedure usually takes about 30 to 60 minutes.

Setting

This procedure is typically performed in an outpatient surgical center or hospital operating room.

Personnel

• Orthopedic or Neurosurgeon
• Surgical Nurse
• Anesthesiologist (if general anesthesia is used)
• Operating Room Technician

Risks and Complications

• Infection
• Bleeding or hematoma
• Nerve damage or recurrence of neuroma
• Scar formation
• Adverse reaction to anesthesia

Benefits

• Pain relief is often immediate or occurs within a few days post-surgery.
• Improved hand or foot function and mobility.
• Long-lasting results with low recurrence rates of symptoms.

Recovery

• Immediate post-procedure care includes monitoring and application of ice and elevation to reduce swelling.
• Pain management with prescribed medications.
• Restricted activity for a few weeks, with gradual return to normal activities as advised.
• Follow-up appointments for suture removal and to assess healing.

Alternatives

• Conservative management (physical therapy, orthotic devices, anti-inflammatory medications)
• Steroid injections
• Radiofrequency ablation or cryotherapy for nerve pain relief

Pros and Cons of Alternatives:

• Conservative treatments are non-invasive but may offer temporary relief and require ongoing management.
• Invasive treatments are more definitive but have associated surgical risks and recovery time.

Patient Experience

• During the procedure: Minimal discomfort due to anesthesia; possible sensations of pressure.
• Post-procedure: Some soreness and swelling expected; pain managed with medications.
• Full recovery includes gradual improvement in pain and function over several weeks.