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June 25, 1982

Metatarsal Neuroma-Reply

JAMA. 1982;247(24):3314. doi:10.1001/jama.1982.03320490018020

In Reply.—  I did not include Gauthier's article in which incision of the intermetatarsal ligament is considered adequate treatment of metatarsal neuroma. In the same journal, Lassman1 described 133 patients and noted that "the only lasting relief from pain comes from resection of the affected interdigital nerve." Vainio2 recorded metatarsalgia in 52 rheumatoid patients and recommended removal of the tumorlike formations to give "uniformly good results." Most surgeons incise the intermetatarsal ligament as a step in the excision of the nerve,3 but few have consistent success with any technique. Gauthier recorded that he needed a "second look" in three patients, and six patients never obtained relief from pain. The poor results are more likely caused by pain syndromes than surgical techniques.