Mortons Neuroma: New Treatments

In 1876, Morton described a painful condition of a nerve between the fourth and fifth metatarsal bones in the foot.  Mortons Neuroma is not a true neuroma as the name implies, and terminology such as neuritis or neuralgia may be more accurate.  Neuroma’s more commonly occur in the fourth plantar interdigital nerve (3rd interspace) where this nerve tends to be thicker/largersecondary to being formed via a branch from the medial and lateral plantar nerves.   The nerve becomes mechanically entrapped and irritated by the deep transverse metatarsal ligament and repetitive micro-trauma of compression and stretching forces results in thickening, fibrosis, and degeneration changes to the nerve.

Symptoms

  • Pain in ball of foot
  • Burning, tingling, numbness, or cramping with possible radiation to toes
  • Feeling of walking on a rock or pebble in ball of foot

Causes of Morton’s Neuroma

  • Tight or narrow shoes
  • Pes planus or pes cavus foot type
  • Trauma or injury

Diagnosis

  • Pain with deep intermetatarsal palpation with simultaneous squeezing of forefoot causing reproducible palpable click
  • Possible splaying of adjacent toes
  • Diagnostic injection into the interspace
  • Imaging : usually negative radiograghs (x-rays), positive findings with diagnositic ultrasnograghy and magnetic resonance imaging (MRI)
  • Nerve studies rule out tarsal tunnel or other etiologies if warranted

Conservative Treatment for Morton’s Neuroma

  • Shoe modifications
  • Orthotics and padding
  • Steroid injections
  • Sclerosing injections (alcohol injections)
  • Cryotherapy
  • Surgical Treatment for Morton’s Neuroma
  • Neurolysis and nerve decompression
  • Neurectomy

A trial of conservative treatment for Mortons Neuroma including shoe gear modifications, padding, and custom orthotics should be performed.  In some cases a consideration of diagnostic and/or therapeutic steroid injections can be implemented.  However, in recalcitrant (chronic) cases, we recommend a trial of ultrasound guided Alcohol Sclerosing Injections into the nerve.  Dehydrated alcohol is mixed with local anesthetic which has a higher affinity for nerve tissue and produces a chemical neurolysis through dehydration and necrosis.  Multiple research studies have demonstrated 84% to 94% improvement of neuroma symptoms and up 84% complete relief.  Sometimes a series of injections is needed. No restrictions in activity are required after each injection.

We hope this information on Mortons Neuroma is helpful to the understanding of this specific foot probelm.

University Foot and Ankle Institute has several locations in Southern California: Los Angeles, Beverly Hills, Santa Monica, Valencia, Torrance, Manhattan Beach, Sherman Oaks, West Hills, Bellflower and Cypress, CA. We are recognized world wide for our expertise in Morton’s Neuroma treatment options and our California podiatrists and surgeons are here to help!

Please call 877-501-0193 now to make an appointment at an office near you.

Dr. Bob Baravarian, DPM, FACFAS
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Dr. Bob Baravarian, DPM, FACFAS

Dr. Bob Baravarian is a Board Certified Podiatric Foot and Ankle Specialist. He is currently a member of UCLA Medical Group, Chief of Podiatric Surgery at Santa Monica/UCLA medical center and Orthopedic Hospital and an assistant clinical professor at the UCLA School of Medicine. He also serves as co-director of University Foot and Ankle Institute. He is Editor Emeritus of the international medical journal, Foot and Ankle Specialist.

Dr. Baravarian has been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He servers as a consultant to the ATP (Association of Tennis Professionals) tour, multiple running organizations and several shoe manufacturers. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),

Podiatrist Dr. Bob Baravarian is available for consultation at the Santa Monica, Sherman Oaks and UCLA Westwood offices.
Dr. Bob Baravarian, DPM, FACFAS
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