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INTERMETATARSAL (DORSAL WEB) APPROACH

USES

This approach is used for interdigital neuroma resections and for dorsal approaches to the metatarsophalangeal joints.

ADVANTAGES

By staying on the dorsum, the scar is kept off of the plantar aspect of the foot, which can be painful with walking.

DISADVANTAGES

This approach provides poor exposure for any of the plantar structures, and accessing the plantar aspect of the metatarsophalangeal joints is difficult.

STRUCTURES AT RISK

The digital artery and nerves are the main structures at risk. This far distal they are small and sometimes difficult to identify. They come from the plantar side toward the dorsal side, which helps somewhat with identification.

TECHNIQUE

A straight incision is made for 3 cm starting in the web space and proceeding proximally, through the subcutaneous tissue, exposing the intermetatarsal area. The tendons are retracted out of the way. The lumbrical tendon is usually retracted laterally. The intermetatarsal ligament crosses the bottom of the joint and is the key structure in identifying the neuroma. This ligament is transected. A lamina spreader is placed between the metatarsals to open the gap. At that point, the neurovascular structures can be identified and the nerve resected.

TRICKS

Related posts:

Volar Approach to the Basal Joint of the Thumb (for Bennett’s Fracture) Paronychium Approach Anterior Approach Deltopectoral Approach Posterior Approach Anterior Approach to the Cervical Spine

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