Morton's Neuroma

[scdreamer]

Has anyone had the endoscopic treatment for Morton's? I've been reading a little about it - seems that it was developed in the 1990s, and rather than removing the nerve, the ligament is repositioned? Not sure if I have that right ... but it seems that there are fewer post-op complications.

Anyone have info or experience with this possibility?

[scdreamer]

I copied and pasted the following information from another website --- Does anyone have first-hand experience with this procedure?

"Dr. Morton's original treatment plan as described in 1876 included changes in shoes, multiple injections of cortisone and if necessary, complete excision of the common intermetatarsal nerve. We've mentioned before that Morton's Neuroma is a nerve entrapment much like carpal tunnel. Now let's see if we can apply Dr. Morton's treatment plan to any other nerve entrapment such as carpal tunnel syndrome. Perhaps we'd splint the wrist, try some injectable cortisone, but completely excise the nerve? No way. But that's what's been done for the past 100 years for Morton's Neuroma. Post-op complications were common and included thinning of the plantar fat pad and loss of sensation in the 3rd and 4th toes.

The introduction of Dr. Steve Barrett's EDIN procedure has revolutionized the treatment of Morton's Neuroma and really represents the first unique contribution to treating this condition in over 100 years. The EDIN procedure stands for endoscopic decompression of the common intermetatarsal nerve. Interestingly enough, Steve describes first thinking about this procedure as he watched another surgeon perform an endoscopic carpal tunnel surgery. Steve recognized the problem to be the ligament and not the nerve. The EDIN procedure selectively releases the ligament and leaves the nerve intact.

The EDIN procedure provides us with a new alternative. In the past we knew that the traditional surgery used to treat Morton's Neuroma, called a neurectomy, was destructive and carried with it a number of post-op complications. Therefore, we would tend to use excessive amounts of cortisone to avoid surgery. The EDIN procedure provides a new alternative using non-invasive endoscopic techniques that usually return patients to activities much sooner than the traditional surgery. And, what I find most helpful is the fact that it enables us to use less cortisone, thereby avoiding fat pad atrophy. The question remains; was the common complication of fat pad atrophy due to the neurectomy itself or did it result from the overuse of cortisone? The EDIN procedure shows none of the traditional post-op complications that were so commonly seen in the neurectomy, therefore we can assume that fat pad atrophy was in part due to overuse of cortisone.

The EDIN procedure has been used for at least ten years and has shown promising results. It can be technically challenging for some who are not familiar with endoscopic techniques. As with other surgical procedures there are pros, cons and possible complication that need to be discussed thoroughly with your physician prior to surgery. The following pictures show the technique used to perform an EDIN procedure. Image 1 shows pre-operative markings identifying the 3rd and 4th metatarsal heads. Image 2 shows placement of the cannula through an interdigital incision. The cannula is much like a small 4mm drinking straw with a slot cut in one side. The slot or open side of the cannula is placed adjacent to the intermetatarsal ligament. The cannula passes from between the toes to a second incision on the plantar aspect of the foot just proximal to the weight bearing surface. The endoscope and knife are used within the slotted cannula to identify and transect the intermetatarsal ligament. Image 3 show the use of a blunt probe without the cannula to verify a complete release of the intermetatarsal ligament. In the bottom of image 3, a metatarsal spreader can be seen. The spreader is used to separate the 3rd and 4th metatarsals subsequently putting pressure on the intermetatarsal ligament. The procedure takes about 20 minutes and is completed in a hospital or surgery center. Local anesthesia with sedation is used. Patients return to regular shoes in two days with just a band-aid on the incisions."

[ndone]

Where and what website can you find out more about this procedure?

[scdreamer]

http://www.myfootshop.com/xq/ASP/Method.Condition/Value.Mortons%20Neuroma/qx/searchresults.htm


That is the site where I found the information regarding the EDIN. Interesting article ... I have followed up on other sites, and found that the doctor who pioneered this procedure does not practice in my state (California). I hope there is someone who has been trained and is experienced near me, so that I can get more information. It really does sound like a better way to go than cutting out the entire nerve.

[ndone]

Thanks for the info, Dr. Barrett is the Dr. who perfected this treatment, I have e-mailed him to inquire about the cost,we live in North Dakota, also asked if there are any Docs in the Minnesota area who do this procedure. Sounds like a promising procedure. We are scheduled for a second cryo in Mpls. on April 4th.

[scdreamer]

I'd really be very interested in what kind of repsonse you get - will you be sure to post here? I hope you have a good outcome whatever you decide to do. I am still having enough relief from the initial cortisone injection - and still waiting for my orthostics to arrive - so at this point I'm not ready to pursue anything more invasive. But it certainly appears that MN does NOT resolve on its own, so I would imagine down the road I will be investigating possibilities.