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:
- Injections of local anesthetic and corticosteroids
- Chemical Neurolysis
- Shoe with a wider toebox
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.
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.
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.
- Saygi B, et.al. Morton neuroma: comparative results of two conservative methods. Foot Ankle Int. 2005 Jul;26(7):556-9.
- 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
- 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.
- Akermark C, Plantar versus dorsal incision in the treatment of primary intermetatarsal Morton’s neuroma.Foot Ankle Int. 2008 Feb;29(2):136-41.