Neuroma and its Various Treatments

A neuroma or Morton’s neuroma is defined a painful condition that involves the ball of the foot. Commonly, the area between the third and fourth toes is affected. The pain can be felt as sharp burning pain, stinging, or a feeling of numbness. In a small number of patients, the nerve pain can occur between the second and third toes.

The reason behind this is usually because of an injury, irritation, or pressure. A neuroma is sometimes described as a nerve tumor although this may not always be true. A neuroma is a swelling in the nerve that may bring about permanent nerve damage.

Although the exact cause for neuroma is unknown, there are certain factors that are believed to play a role in its development. These include having flat feet, high foot arches, abnormal positioning of the toes, bunions, and hammertoes. Wearing tight fitting shoes and high heels was also found to be a contributing factor. This may be why more women are affected compared to men.

In the diagnosis of neuroma, a thorough physical examination is the first step. There is usually tenderness on the involved area upon compression. Sometimes, there is a tingling sensation when the sides of the foot are squeezed. To rule out bone problems, a foot x-ray is often done. Other tests are magnetic resonance imaging or MRI, ultrasound, and electromyography or nerve testing.

There are basic treatments that usually resolve the pain in neuroma. Resting the foot is the simplest. Using foot pads or arch supports can help minimize the pressure on the nerve. These can either be custom made or bought over the counter. Taping the toe area is another way to manage pain. Staying away from high heeled shoes and wearing shoes with wider toe boxes also help.

Taking anti inflammatory medications, other painkillers, or injection of nerve blocking medicines into the toe area may also be suggested. However, painkillers are not to be used for long term management. Cortisone injections and the use of orthotics may be combined to manage the condition.

In a small percentage of patients, surgery may be needed. This is especially true when the nerve has become damaged permanently. Decompression surgery involves cutting nearby structures to relieve pressure on the nerve thereby alleviating neuroma pain. Sometimes, surgical removal of the nerve may be necessary if other treatments do not provide relief from pain.  As with any surgical procedure, complications can occur such as excessive swelling, infections, healing problems, bleeding, scarring, or continued pain. Regrowth of a more painful neuroma can happen also.

ESWT or extracorporeal shock wave therapy is now also starting to be utilized for neuroma pain that does not respond to the usual methods and an alternative before proceeding to surgery. In this treatment method, powerful but painless energy pulses are used to induce microtrauma to the tissues. In turn, the natural healing process is induced in the area. Studies have shown the potential of ESWT neuroma treatment for persistent pain that is not responsive to the usual management methods. This technique is great for people with previous neuroma surgeries where it is actual scarring that causes the pain. In our practice, Family Foot and Leg Center, PA 80% resolution in 4 wks and 100% resolution in pain after the 5 months for majority of patients who have undergone ESWT for treatment of pain after neuroma surgery.

Our newest addition it the RF ablation therapy. It is heat that is generated by a probe that injures the nerve to the point where it no longer sends pain signals. Pain management doctors have been doing this for the neck and lumbar spine issues. FFLC, has been using this for neuroma management with great success for those that fail the usual treatments as mentioned earlier.

We have minimized greatly the number of patients having to undergo neuroma surgeries. This surgery very unpredictable even in the best of surgical hands.