University Foot & Ankle Institute
Select a department...
  • University Foot & Ankle, a Preferred Provider to:
  • UCLA Health System - UCLA Medical Group
  • MPTF - Motion Picture Television Fund
  • And consulting physicians for:
  • C&S - Cedars-Sinai
  • Saint John's Health Center

Neuroma and Nerve Pain: Morton's Neuroma

What is Morton's Neuroma?

Mortons Neuroma, University Foot Ankle Institute

 

A neuroma is a benign growth or inflammation of nerve tissue. When the swollen or thicken nerve is in the ball of the foot it is known as Morton’s Neuroma.  The inflamed nerve can cause pain and discomfort; it may feel as if you are walking on a pebble on the ball of your foot.

 

Foot neuromas most often affect the nerve between the third and fourth toes, frequently in response to injury or over-use of the nerve. Neuromas rarely occur between any other toes and usually affect only one foot.

 

Often when patients come to us for a second opinion for a neuroma that is not getting better, we discover they  have been misdiagnosed and actually have a plantar plate tear of the toe joint. While they have similar symptoms in the same area of the foot, they are very different conditions with different treatments.

I want you to know how much I appreciate all of your efforts to help me and how much I truly respect you as a person and a doctor. Your kindness has brightened my world on many days that would have otherwise been gloomy. Andrew

What causes a Foot Neuroma?

 

A neuroma is often caused by an overuse or repetitive motion of the foot and toes. It can also be caused by blunt trauma to the forefoot or direct insult to the nerve.  Over time the continued and static compression of the nerve will cause more severe damage to the nerve and lessen the success of conservative treatments.

 

Foot Neuroma University Foot and Ankle Institute

How do we diagnose a Neuroma?

 

Clinical evaluation of the foot is the most important way to evaluate for a neuroma. Palpation of the foot between and just behind the metatarsal heads will elicit pain and often electric shooting into the toes. Squeezing of the forefoot from side to side can reproduce the symptoms as well.

 

Plain x-rays can show if there is any bone involvement that many contribute to the damage to the nerve. Special neurosensory examinations (PSSD) may need to be performed in order to evaluate the extent of the nerve damage. Ultrasound examination and MRI can also shoe the enlarged nerve in severe cases.

 

 

What are the conservative treatments for Morton's Neuroma?

 

In the early stages of a neuroma, conservative treatments are often successful. These include:

 

Removal of the deforming force and stopping the activity that is causing the injury

This is an important first step because if you do not remove the cause(s) of the problem, you are simply treating the pain will not fix the actual problem. If your shoes are contributing to the problem, you will need to wear different shoes. If a particular activity is causing the injury, you will need to stop that activity, at least long enough for it to heal.

 

Immobilization

In some acute cases, immobilizing your foot for a period of time can be very helpful. This is achieved by wearing a special shoe or boot.

 

Physical Therapy

Physical therapy is another very effective treatment for neuromas in their early stages.

 

Steroid Injections

In acute cases, catabolic steroid injections (cortisone) can be very helpful in reducing pain and symptoms, as well as helping to cure the neuroma.

 

Custom Orthotics

Custom molded orthotics with special padding is often an important part of treatment and also lessens the chance for the neuroma to return.

 

 

What if conservative treatments for Neuroma don’t work, then what?

 

In more severe and chronic cases that have failed conservative therapies, there are four main treatments available, some more invasive than others.

 

Each treatment below has unique benefits or downsides so each patient has a customized treatment plan that takes into account not only only the patient’s physical condition but the day-to-day personal and professional needs. These advanced treatment options for Neuroma are:

 

Cryotherapy

This is the method of freezing of the nerve. A small incision is made over the area of the nerve. A wand from the cryotherapy device is inserted into the wound and placed over the nerve. The device is set to a specific amount of time during which it freezes the nerve. Read more about Cryotherapy.

 

Alcohol Sclerosis

A special alcohol solution is injected over the nerve. This solution has an affinity only for nerve tissue and the end result is to deaden the nerve. The loss of the nerve can then leave the patient symptom free.

 

This procedure stops the nerve from transmitting nerve signals and therefore there is less pain. Most patients respond well to the treatment which is office based and done under local anesthesia. In certain cases, the procedure does not fully treat the nerve pain on the first attempt and a second treatment may be necessary.

 

Nerve Decompression

One of the most recent advances in neuroma therapy is nerve decompression. In many cases, the overlying ligament that connects the metatarsal heads together is pinching the nerve. A simple surgery releases this ligament allowing for increased space for the nerve and relief of pain. This surgery leaves the nerve intact and allows continued sensation to the toes.

 

Nerve Excision

This is the most traditional treatment for neuroma pain. This procedure allows for removal of the nerve from the metatarsal head region and thus decreases or removes pain. There is risk of the remaining nerve regrowing or scarring but overall, with proper technique, the risk is minimal.

 

 

Why choose the podiatrists at UFAI for Morton's Neuroma Treatment?

 

The physicians at Foot and Ankle Institute have performed a great deal of research and treatment advancements related to neuroma care. We prefer to avoid nerve excision and save this for severe cases, cases in which conservative care and the less invasive procedures did not work.

 

The podiatrists, surgeons and physical therapists at University Foot and Ankle Institute are known as the leaders in the advancement of foot and ankle technologies, education and research. Our physicians are among the very best in California and are available to you throughout Southern California. To request an appointment with a doctor please call (877) 989-9110.