What Is A Neuroma?
A Mortons’ Neuroma is a very common condition affecting the nerves of the ball of the foot. The nerves in this area (between the toes) become painful and inflamed.
What Are The Symptoms Of Neuroma
Patients with neuroma may develop pain on the bottom of the forefoot, most commonly under the 3rd and 4th toes, though any toe may be affected. The pain may be dull and mild or severe and sharp. The toes may feel ‘numb’ as times, especially the area between the 3rd and 4th toes. A classic complaint is that patients feel as if they are “walking on a stone or pebble” and/or “feel as if the sock is rolled up in the shoe.” Pain is often worse when walking barefoot.
Causes of Neuroma
There are many reasons to develop a neuroma. Improper shoe gear is probably the most likely cause. Repetitive activity and excessive pressure on the ball of the foot are common. Heredity and genetic factors may also be involved. In many cases the structure of the foot may predispose the condition. Associated conditions that may cause neuroma include: bunion, hammer toes, ligament laxity, and/or a tight calf muscle. Some patients may have thinning of the fat pad on the ball of the foot, which may result in increased pressure of the nerves. Tight pointy shoes (and high heels) without padding may induce pain in the ball of the foot. Neuroma may occur suddenly, or develop over time.
When to Seek Treatment
Common reasons patients seek treatment are: ball of the foot becomes painful, interferes with walking or activities, experiences difficulty fitting shoes, swelling, calluses/corns and/or notice a change in appearance of the foot and/or toe(s).
Depending on your overall health, symptoms and severity of the neuroma, the condition may be treated conservatively and/or with surgery.
Non-operative Treatments For Neuroma
Non-surgical methods for neuroma are aimed at decreasing and/or eliminating symptoms (pain).
Simple Treatments Patients Can Do:
● Wear proper supportive shoes
● Use an arch support
● Wear shoes with a wide toe box
● Modify your activities
● Lose weight
● Wear shoes with cushion
Non-surgical treatments Dr. Blitz can add:
● Prescribe an oral anti-inflammatory medication
Anti-inflammatory medication is useful to significantly reduce pain and inflammation.
● Prescribe physical therapy
A physical therapist may perform ultrasound and other techniques to reduce inflammation. You will also be instructed how to stretch your foot and leg properly.
● Prescribe protective pads
Padding and/or cushioning of the ball of the foot is an effective method of preventing physical irritation with shoes. Pads with cutouts say off-weight specific areas of concern.
● Prescribe custom foot orthotics
A custom foot orthotic is a doctor prescribed arch support that is made directly from a casting (mold) of your feet, and theoretically should provide superior support compared to shoe insert that you would purchase from a pharmacy.
● Give cortisone injection
A cortisone injection is a powerful anti-inflammatory medication that is used to rapidly reduce the pain associated with an inflamed nerve. The pain relief that you may experience from the injection(s) is often temporary. Typically injection(s) are administered once every 2 months for a total of 3 injections or until the pain is resolved.
● Give sclerosing alcohol injection
A sclerosing alcohol injection is placed around the involved nerve to weaken its capacity to report pain. In other words, the alcohol injection will ‘deaden’ the affected nerve. The pain relief that you may experience from the injection(s) can be permanent. Typically injection(s) are administered once every week for a few weeks until the pain is resolved.
Morton’s Neuroma Surgery
Surgery for neuroma most often involves removing affected nerve in the ball of the foot. An incision is made on the top of the foot and the nerve is carefully removed. Surgeon must remove the nerve far enough back so that the nerve doesn’t continue to become impinged at the ball of the foot. Alternatitvely, another type of surgery involves releasing a tight ligament that encases the nerve, though Dr. Blitz does not find that particular method effective. As such, he finds simple neurectomy to be the best option for the surgical treatment of Morton’s Neuroma.
Morton’s Neuroma Surgery Recovery
Recovery after Morton’s neuroma (neurectomy) surgery is generally quick. Typically patients are walking on the operated foot in a post-surgical shoe for 2 – 4 weeks, depending on healing. Return to shoes is 2-6 weeks after the surgery. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.
What Anesthesia Is Needed For Foot Neuroma Surgery
Morton’s neuroma surgery is performed as outpatient surgery (this means you go home the same day). It may be performed in a hospital, ambulatory surgery center and even in the doctors office (so long as the facility is set up for surgery).
The surgery can be performed under a local, regional, spinal or general anesthetic. Local and regional blocks, with monitored anesthesia care are most commonly performed. This means that the foot will be numbed with an anesthetic while an anesthesiologist provides sedation to relax you.
What Are The Risks Of Morton’s Neuroma Surgery
There are general risks associated with neuroma surgery (or any surgery) and the use of anesthesia. Complications may occur and are not necessarily your fault, or the fault of your surgeon. Nonetheless, you should understand the risks.
Morton’s Neuroma surgery complications include, but are not limited to: infection, pain (temporary or permanent), swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), malunion, nerve injury, neruoma, pain syndrome, RSD, disability, recurrence, flail toe, hammer toe deformity, metatarsalgia, unsightly scar, stiffness, shortness of toe, weakness in toe, loss of toe to purchase ground, hardware problems, need for revisional surgery, and/or catastrophic loss.