Targeted Muscle Reinnervation for a Symptomatic Neuroma in a Traumatic Transmetatarsal Amputee: A Case Report

Area of Science:

• Regenerative medicine
• Neurosurgery
• Orthopedic surgery

Background:

• Neuromas are a common complication following amputation, causing significant pain and functional impairment.
• Post-transmetatarsal amputation can lead to neuroma formation on the plantar surface of the foot.
• Traditional treatments for amputation neuromas have variable success rates.

Purpose of the Study:

• To describe a novel application of targeted muscle reinnervation (TMR) for treating a painful neuroma in a patient with post-transmetatarsal amputation.
• To evaluate the efficacy of coapting the tibial nerve to the flexor hallucis longus (FHL) motor point for neuroma pain relief and functional recovery.

Main Methods:

• A case study of a 48-year-old male with a painful plantar neuroma following left post-transmetatarsal amputation.
• Surgical intervention involved targeted muscle reinnervation (TMR) by coapting the transected tibial nerve to the motor point of the flexor hallucis longus (FHL) muscle.
• The surgical approach aimed to reroute nerve signals away from the neuroma site.

Main Results:

• The patient experienced complete resolution of resting neuroma pain at the 1-year follow-up.
• The patient was able to return to work post-surgery.
• Ambulatory function improved, with the patient able to walk for 30 minutes with an orthosis.

Conclusions:

• Tibial nerve coaptation to the FHL muscle via TMR presents a viable treatment option for neuromas in traumatic post-transmetatarsal amputations.
• This TMR technique offers a potential solution for refractory neuroma pain in amputees.
• Further research into rare nerve coaptations for amputation-related neuroma treatment is warranted.