Bulb Neuroma

A large stump of nerve tissue develops as a result of scarring of the nerve (left 2pics) after surgical resection of a neuroma which can very painful and in some cases more painful than the original neuroma. The resected nerve is sometimes sutured into the muscle to prevent this from occuring (bottom 3).

 

The large stump neuroma is then isolated from the surrounding tissue attachments (left) and removed completely from the intermetatarsal space (right).

When a nerve is cut, the piece of nerve that is beyond the cut point eventually dies. However, its Schwann cells, the cells that encircle the nerve fibers, remain for a much longer time. These Schwann cells secrete a chemical messenger known as nerve growth factor that tells the cut end of the nerve where to grow back. So the cut end of the nerve will send out multiple sprouts in the direction of the nerve growth factor. However, these sprouts do not go out in an orderly manner, instead, they grow out in all directions and eventually cluster and form a knot of nerve fibers. This eventually leads to the formation of a TRUE neuroma or an END BULB or STUMP neuroma. If it is in a place on your foot where you put a lot of pressure, it will become very painful.

To treat a painful TRUE neuroma, the enlarged bulb and or sprouts are resected and implanted into the deep muscles of the forefoot or of the arch where the nerve feels more "at home". This takes the nerve out of a weightbearing region, into a quieter region where it will not be subject to weight or compression.

This is a picture of  bulb sural neuroma that was removed the remaining nerve was sutured to the peroneal muscle

 

  

Intraop Pics of Sural nerve that was entrapped.  We released the nerve and attached the stump of the nerve into the peroneal muscle with suture