Morton's Neuroma

In this video Dr. Baravarian explains Morton's Neuroma and the available progressive treatments at UFAI.


A neuroma is a benign growth or inflammation of nerve tissue
and when it occurs is in the ball of the foot, it's called Morton’s Neuroma. The inflamed nerve causes pain and feels like you're walking on a pebble all of the time.

 

These mostly occur in response to an injury or by over-use and normally affect only one foot.

 

UFAI is nationally recognized for the research and treatment advances we have pioneered. We always try to avoid surgery and begin with less invasive treatments whenever possible.

What Causes a Foot Neuroma?

UFAI patient Bill talks about his Moton's neuroma surgery and what a difference it's made in his life.

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.

 

 

Diagnosing 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.

 

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. Read more about plantar plate tears here.

 

 

Conservative Treatments for Morton's Neuroma

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

 

Remove the deforming force and stop the activity 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.

 

 

Advanced Morton's Neuroma Treatment Options

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 the patient’s physical condition but also the day-to-day personal and professional needs.

Some advanced treatment options for Morton's neuroma are:

 

Cryotherapy

This is the method of freezing of the nerve. Using ultrasound guidance, 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.

 

Morton's Neuroma Surgery: 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.

 

Morton's Neuroma Surgery: 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.

 

 

What’s a Stump Neuroma?

A stump neuroma is simply a neuroma that gets surgically removed and then regrows. Having this condition is not only painful but very disappointing because the patient had already gone through surgery once, and will probably need to go through it again. A surprisingly large number of our patients (up to 25%) come to us to have surgeries performed elsewhere corrected and Morton’s Neuroma is no exception.

 

Nationwide, It is estimated that between 30% to 40% of morton neuroma surgery patients end up with stump neuroma though fortunately our own patient’s rate of re-occurrence is rather rare (around 2%). Why?

After years of research and studies, we have learned that burying the nerve into the arch musculature dramatically reduces stump neuromas and post-surgical problems. Since a stump neuroma forms when the nerve is looking for something to innervate, when we put it in the muscle, the nerve thinks it is doing its job and thus rarely causes problems.

 

 

UFAI, We’re Near and Here When You Need Us!

Mortons Neuroma treatment, foot nerve pain

At University Foot and Ankle Institute we truly committed to offering the very best foot and ankle care and experience.

 

We have nine conveniently located offices throughout Greater Los Angeles and Southern California including: Sherman Oaks, Manhattan Beach, Valencia, West Hills, Torrance, Santa Barbara, West Los Angeles, Beverly Hills and Santa Monica. Our locations offer a full-range of services including radiology, Physical Therapy, MRI, neurosensory nerve testing and ultrasound.

 

In addition, we are pleased to offer state of the art surgical centers and physical therapy services conveniently located within our Valencia and Santa Monica Podiatry locations.

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