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INTERMETATARSAL NEUROMA S ARE a common cause of forefoot pain. They involve perineural fibrosis of a plantar intermetatarsal nerve (typically of the third intermetatarsal space) mediated by repetitive microtrauma. Though many di–erent diagnostic modalities have been suggested, including ultrasound, ultrasound-guided diagnostic injections and even electrodiagnostic studies, the majority of cases can be diagnosed with a focused physical exam that targets the interspace as the sight of reproduced pain. In my experience, MRI is occa- sionally necessary to rule out adjacent metatarsophalangeal joint pathology. Shoe gear modifications, orthotics, padding, injections, radio- frequency ablation, nerve decompression, and neurectomy are all treatment approaches utilized today. My practice experience has shown that while corticosteroid injections can provide symptom relief for some patients, surgical excision is necessary in the vast majority. This practice experience mirrors what Jain and Mannan discussed in their paper published in 2013. Their literature review revealed that 80 percent of patients ultimately require surgical excision of the lesion. 1 Regarding surgical excision, dorsal and plantar incisional approaches are described, and both have their merits. In fact, multiple reports reveal good and predictable clinical outcomes for both approaches. 2 My preference over the years has been the dorsal approach, as it has demonstrated good visualization of the plantar digital branches, which consistently leads to reliable neuroma visualization. Finally, proximal intermetatarsal nerve exposure and transection in the preferred environment of interosseous muscle tissue has consistently been easier using a dorsal approach. Dr. Je¢rey Whitaker is board-certified in foot surgery and in reconstructive rearfoot ankle surgery by the American Board of Foot and Ankle Surgery. He is Division Head and Associate Professor of Podiatric Surgery at Kent State University College of Podiatric Medicine in Independence, Ohio. ■ References 1. Jain S, Mannan K: The diagnosis and management of Morton's neuroma: a literature review. Foot Ankle Spec 6(4): 307-317, 2013. 2. Akermark C, Crone H, Skoog A, Weidenhielm L: A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton's neuroma. Foot Ankle Int 34(9): 1198-204, 2013. One Surgeon's Perspective on Intermetatarsal Neuromas BY JEFFREY M. WHITAKER, DPM, FACFAS When taking care of patients is only part of the equation, you want a top-ranked law firm. WE DO OUR JOB SO YOU CAN DO YOURS. Our team of health care attorneys have the knowledge and experience to understand the current challenges confronting physicians and health care businesses. We do what we do, so you can focus on medicine. We advise and counsel health care providers in all areas of their business: • HIPAA compliance • Fraud and abuse compliance • Employment contracts • Mergers and acquisitions • Corporate compliance for non-profits • Affordable Care Act • Employment matters, including contracts, OSHA and workers' compensation • Supplier, third-party provider and insurance provider agreements • Practice formation and operation 4775 Munson Street NW | Canton, Ohio 44718 877.876.9958 | 330.497.0700 Offices in Canton, Akron, Alliance, New Philadelphia and Sugarcreek KWGD.com M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N n M AY/J U N E 2 016 1 9