Neuroma
Neuromas usually cause pain in the forefoot, especially in the
area of the 3rd and 4th toes. The pain may be shooting, burning,
stabbing, radiating and/or just an odd feeling in the area. Often, pain
decreases with removal of shoe and massaging the area.
Effective
Non-surgical Treatment
Our goal when
treating neuromas is to relieve your pain, and prevent the neuroma from
returning. We can treat most neuromas non-surgically and surgery is
reserved as a last resort.
Conservative Treatment Usually Prevents the Need for Surgery
Dr. Hale and Dr. Huppin are extremely successful at treating neuormas
conservatively. Surgery is rarely necessary, but the sooner you are
treated the less likely surgery will be necessary, so
make an appointment to see us as soon as
possible. Conservative treatment may include:
What Is A Neuroma?
A Morton’s neuroma is a fibrous thickening of the nerve in the area of
the 3rd and 4th toes.
 
What Causes A Neuroma?
The exact cause is unclear. However, it is thought the bones on either
side of the nerve pinch the nerve causing inflammation and thickening.
Known contributing factors are tight shoes, especially slip on shoes,
and biomechanical dysfunction such as flat feet. Also, injury or foot
sprains may cause a neuroma.
How Do I Know If I Have A Neuroma?
- Clinical examination by a physician (usually feels for a palpable
click between the metatarsal heads).
- Diagnostic Ultrasound
Imaging to evaluate the neuroma
- X-ray of the foot to rule out other foot pathologies.
Conservative Treatment Usually Prevents the Need for Surgery
Dr. Hale and Dr. Huppin are extremely successful at treating neuromas
conservatively. Surgery is rarely necessary, but the sooner you are
treated the less likely surgery will be necessary, so
make an
appointment to see us as soon as possible. Conservative treatment may
include:
Custom Orthotics Can Relieve Most Neuroma Pain
A recent study demonstrated that custom foot orthotics provided relief
for Morton’s neuroma in 63% of patients1-2. For best results, the
orthotics should be designed to reduce pressure under the ball of the
foot as much as possible. Thus, the orthoitcs must conform extremely
tight to the arch of the foot in order to transfer pressure from the
ball of the foot to the arch. These are called
Total Contact Foot
Orthotics and if properly prescribed and fitted, can help relieve the
symptoms of a neuroma.
In order to ensure best outcomes from your orthotics we first perform a
detailed examination, including slow motion video analysis, of how you
walk and how your feet work. A mold of your foot is then taken in a very
specific position and the orthotic devices are prescribed in a manner to
best reduce force and trauma to the area of your neuroma.
The same study showed that patients treated with a combination of
orthotics and steroid injection had a 82% chance of a successful outcome
without having to resort to surgery.
Figure 1:The foot scan on the left has no orthotic – you can see
increased pressure (red) in the area of the neuroma. The right foot
scan, where a total contact orthotic is used, shows dramatically
decreased pressure
What Will Happen If I Don’t Have My Neuroma Treated?
It is difficult to predict the sequelae and rate of progression of an
untreated neuroma. Usually if a neuroma is untreated the following
occurs:
- Growth of the neuroma
- Increased discomfort in the area
- Inability to wear certain shoes
- Inability to perform some job duties
- Need for surgical removal
When Is Surgery Indicated?
When conservative therapy has failed to provide adequate relief of
symptoms or conservative treatment options are impractical.
What Is Involved In Neuroma Surgery?
Surgery is usually performed under local anesthesia with an IV
medication to make you sleepy. After surgery you will have to keep your
foot dry for two weeks. Generally neuroma surgery allows for early
weight bearing and protection in some type of post op shoe gear for
three to four weeks. Some neuromas may reoccur, but this is rare.
Most studies on patient satisfaction after neuroma surgery show
approximately 90% reduction of pain and about 85% of all patients rated
the overall satisfaction with the results as excellent or good. 3-4
Don’t let your neuroma pain get worse. Early treatment can prevent
future problems.
Call today for
an appointment in our Seattle office.
1. Saygi B, et.al. Morton neuroma: comparative results of two
conservative methods. Foot Ankle Int. 2005 Jul;26(7):556-9.
2. Leslie C. Trotter and Michael Raymond Pierrynowski The Short-term
Effectiveness of Full-Contact Custom-made Foot Orthoses and
Prefabricated Shoe Inserts on Lower-Extremity Musculoskeletal Pain: A
Randomized Clinical Trial J Am Podiatr Med Assoc 2008 98: 357-363
3. Akermark C A prospective 2-year follow-up study of plantar incisions
in the treatment of primary intermetatarsal neuromas (Morton's neuroma).
Foot Ankle Surg. 2008;14(2):67-73. Epub 2008 Feb 21.
4. Akermark C, Plantar versus dorsal incision in the treatment of
primary intermetatarsal Morton's neuroma.Foot Ankle Int. 2008
Feb;29(2):136-41.
All pages on this website © 2005-2009
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.
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