PLANTAR NEURECTOMY 163 



PLANTAR NEURECTOMY 



From our description of the nerve it will easily be gathered that 

 plantar neurectomy is indicated in any incurable non-suppurating affec- 

 tions of the foot or the region below the fetlock, e.g., navicular disease, 

 true ringbone affecting the pastern or corono-pedal joints, pyramidal 

 disease, &c. Where the affections are confined to the inner aspect of 

 the Hmb or foot, neurectomy of the median nerve has a great advantage 

 over double plantar neurectomy, inasmuch as by adopting the former 

 operation sensation is destroyed in these regions, whilst a supply to the 

 external aspect of the limb and foot remains in the distribution to those 

 parts of the ulnar nerve already described. 



In performing neurectomy of the internal plantar nerve the selected 

 seat is about one inch above the apex of the sesamoid bone on the edge 

 of the perforans tendon, which would be about the line of division 

 between the middle and posterior thirds of the limb. 



If the palmar aspect of the medius finger be applied to the most 

 prominent part of the fetlock, and then moved to and fro in an antero- 

 posterior direction, the digital artery may be distinctly located by the fact 

 that it will be felt to roll beneath the finger. Immediately behind the 

 artery is the posterior digital nerve. Recollecting the fact that this nerve 

 is the continuation of the plantar nerve in a direction which is almost 

 perfectly vertical, a straight and vertical line drawn upwards just behind 

 the point where the digital artery is felt will indicate the exact seat of 

 plantar neurectomy where it intersects a transverse line drawn across the 

 limb about one inch above the apex of the sesamoid bone. Having thus 

 decided upon the seat and adopted the usual preliminary preparation, an 

 incision along the length of the nerve — a vertical incision — should be made 

 through the skin and subcutaneous fascia. The incision should be about 

 three-quarters of an inch in length ; there is no necessity to adopt an incision 

 which has a tendency towards the microscopical, for it is advisable that 



