Austin Foot and Ankle Specialists, Austin, Texas.
Foot Ankle Spec. 2022 Dec;15(6):579-585. doi: 10.1177/19386400221106642. Epub 2022 Jul 1.
Compression and irritation at the plantar aspect of the transverse intermetatarsal ligament may lead to a compressive neuropathy called Morton's neuroma. There are many treatment options for Morton's neuroma, with the most common surgical option being traction neurectomy. While there has been success in many surgical procedures, up to 35% of patients treated with traction neurectomy have recurrent pain and up to one-third of these patients have a recurrent stump neuroma. These neuromas are caused by abnormal axonal growth during regeneration, leading to an unorganized mass of fibrotic collagenous tissues, Schwann cells, and axons. More recent surgical treatments of neuromas have included nerve capping, which has been proposed to prevent painful neuroma formation by isolating the nerve end from external chemosignaling and reducing disorganized axonal outgrowth. An off-the-shelf, biocompatible porcine small intestine submucosa (pSIS) derived nerve cap with internal chambering has been investigated in a rodent study, which showed less pain sensitivity and less axonal swirling indicative of reduced likelihood of neuroma formation. Furthermore, a recent clinical study indicated that patients experienced a significant reduction in pain 3 months after Morton's neuroma excision followed by repair using a nerve cap. This article describes the surgical technique of the aforementioned clinical study to mitigate neuroma formation, where a Morton's neuroma is excised, and the remaining proximal nerve stump is inserted within a nerve cap and buried in the surrounding muscle. Level V: Expert opinion.
横骨间的足底韧带上的压缩和刺激可能导致一种称为莫顿神经瘤的压迫性神经病变。莫顿神经瘤有许多治疗选择，最常见的手术选择是牵引神经切除术。虽然许多手术都取得了成功，但高达 35%接受牵引神经切除术的患者会出现疼痛复发，而多达三分之一的患者会出现残端神经瘤复发。这些神经瘤是由于再生过程中轴突异常生长引起的，导致无组织的纤维胶原组织、雪旺细胞和轴突团块。最近对神经瘤的手术治疗包括神经套，其通过将神经末端与外部化学信号隔离并减少无组织的轴突生长来防止疼痛性神经瘤形成，从而被提出。在一项啮齿动物研究中，已经研究了一种现成的、生物相容性的猪小肠黏膜下（pSIS）衍生的带有内部腔室的神经套，该研究表明其敏感性降低和轴突旋转减少，表明神经瘤形成的可能性降低。此外，最近的一项临床研究表明，接受莫顿神经瘤切除和神经套修复的患者在术后 3 个月后疼痛明显减轻。本文描述了上述临床研究中用于减轻神经瘤形成的手术技术，其中莫顿神经瘤被切除，剩余的近端神经残端插入神经套并埋在周围肌肉中。V 级：专家意见。
