Alternatively, making the incision from the ventral side (the sole of the foot) allows more direct access to the affected nerve without cutting other structures. However, this approach requires a greater post-operative recovery time in which the patient must avoid weight-bearing on the affected foot, because the ventral aspect of the foot is more highly enervated and impacted by pressure when standing. It also carries an increased risk of scar-tissue formation in a location that causes ongoing pain.When a patient has multiple neuromas in the same foot, the most common surgical approach is to remove them all using a single incision.Cryogenic neuroablation (also known as cryoinjection therapy, cryoneurolysis, cryosurgery or cryoablation) is a lesser-known alternative to neurectomy surgery. It involves the destruction of axons to prevent them from carrying painful impulses. This is accomplished by making a small incision (~3 mm) and inserting a cryoneedle that applies extremely low temperatures of between −50 °C to −70 °C to the nerve/neuroma, resulting in degeneration of the intracellular elements, axons and myelin sheath (which houses the neuroma) with wallerian degeneration. The epineurium and perineurium remain intact, thus preventing the formation of stump neuroma. The preservation of these structures differentiates cryogenic neuroablation from surgical excision and neurolytic agents such as alcohol. An initial study showed that cryoneuroablation is initially equal in effectiveness to surgery but does not have the risk of stump neuroma formation.An increasing range of procedures are being performed at specialist centers to treat Mortons neuroma under ultrasound guidance.
Boutonniere deformity is a deformed position of the fingers or toes, in which the joint nearest the knuckle (the proximal interphalangeal joint, or PIP) is permanently bent toward the palm while the farthest joint (the distal interphalangeal joint, or DIP) is bent back away (PIP flexion with DIP hyperextension). Causes include injury, inflammatory conditions like rheumatoid arthritis, and genetic conditions like Ehlers-Danlos syndrome. Pathophysiology
This flexion deformity of the proximal interphalangeal joint is due to interruption of the central slip of the extensor tendon such that the lateral slips separate and the head of the proximal phalanx pops through the gap like a finger through a button hole (thus the name, from French boutonnière "button hole"). The distal joint is subsequently drawn into hyperextension because the two peripheral slips of the extensor tendon are stretched by the head of the proximal phalanx (note that the two peripheral slips are inserted into the distal phalanx, while the proximal slip is inserted into the middle phalanx). This deformity makes it difficult or impossible to extend the proximal interphalangeal joint. Diagnosis
Stages
Mild extension lag, passively correctable
Moderate extension lag, passively correctable
Mild flexion contracture
Advanced flexion contractureHigher numbers indicate a more severe problem and greater likelihood of a poor outcome. Treatment
Usually treated with a splint placing the proximal interphalangeal joint in extension for 4–6 weeks. Occasionally surgery is needed when splinting is unsuccessful. See also
Swan neck deformity
Z-deformity

References
Further reading
Coons, Matthew S.; Green, Steven M. (August 1995). "Boutonniere deformity". Hand Clinics. 11 (3): 387–402. doi:10.1016/S0749-0712(21)00060-3. PMID 7559817. Souter, William A. (October 1974).