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tion described are often helpful. A custom insert with metatarsal padding is also helpful. Very occasionally a second or third injection 3 to 6 months apart may be needed. More injections should be avoided due to the potential for fat pad atrophy. One especially difficult patient to treat conservatively is the competitive cyclist, due to his or her shoe preference. Very stiff soled shoes increase the interdigital pressures, and the foot position in cycling puts increased stress on the metatarsal heads.23
For patients in whom conservative treatment is unsuccessful, surgery is indicated. Discussion of surgery for IDN has revolved around excision of the nerve (with or without transposition) with transection of the transverse metatarsal ligament, to neu-rolysis, to transection of the ligament without excision of the nerve. Dorsal and plantar approaches have been described. The author prefers the dorsal approach for all primary excisions and the plantar approach only for revision surgery. Excision of the nerve with transection of the ligament has the widest popularity, and reports indicate 85% success.21 Care must be taken to excise the nerve very proximally and allow it to retract into the deep muscles of the foot. For the percentage of resections that have persistent pain due to a recurrent neuroma, repeat surgical resection is less successful, with a reported 60% improvement. With a primary neuroma excision, most highly competitive athletes may return to their sport within 4 to 6 weeks postoperatively.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.