Morton’s Neuroma
Patients often feel pain from a Morton’s neuroma on the top of the foot and in the toes. Interestingly, the nerves actually run deep down on the bottom of the foot.
A morton’s neuroma is an inflammed area of nerve pinched between two bones in the foot.
Pain and Numbness in the Toes
We all have tiny nerves that run between the bones in our foot. Sometimes these nerves can get pinched between the surrounding bones. When this happens, they get enlarged and inflammed. Nerve inflammation here leads to symptoms in the forefoot and toes. In particular, you may feel a shooting pain, burning, numbness, or tingling.
The most common neuromas impact the 2nd, 3rd, and 4th toes. Neuromas impacting the big toe (1st) and little toe (5th) are rare.
Both nonsurgical and surgical treatments can prove to be cures. Dr. Bohl specializes in treatment of both first-time and recurrent neuromas.
Diagnosis
Diagnosis of neuromas is a tricky as there are other structures in the nearby area that can cause similar symptoms. Dr. Bohl will obtain x-rays and perform a series of physical examination maneuvers desinged to recreate your symptoms.
In particular, he will test for good innervation of the specific area where a Morton’s neuroma should send its nerve (the bottoms of the two adjacent toes).
In order to confirm the diagnosis, multiple physical examination findings should be concordant, and other potential causes of your symptoms (hammertoes, metatarsalgia, fat pad atrophy, plantar plate injury, synovitis, arthritis, etc.) should be ruled out.
Nonsurgical Treatment
A small injection is the most effective form of nonsurgical treatment.
Once you have a confirmed diagnosis of neuroma, nonsurgical treatment can begin. Nonsurgical treatment includes the following:
Orthotics and shoe-wear changes
Anti-inflammatory medications
Injection of steroid into the nerve
Of these treatment options, injections are the most effective. A good response to an injection also helps greatly to confirm the neuroma as the symptom generator. Injections should help for a few months. Dr. Bohl will be happy to perform several injections spaced a few months apart, which may be all you need for a cure. However, more than a few injections in this area aren’t great, as they can lead to degeneration of the padding on the bottom of your foot and the ligaments that support your toes. If the injection works but wears off, surgical treatment is typically the best solution.
Surgery is the most definitive form of treatment for a Morton’s neuroma.
Surgical Treatment
Surgical treatment is the most definitive solution for a Morton’s neuroma. It is a minor and straightforward procedure in which the neuroma is removed through a small incision on the top of your foot.
Bothersome tingling and pain resolves. Postoperatively, you are allowed to walk and resume activities on the same day.
The main side effect of neuroma removal is a small patch of persistent numbness on the bottom of the toes, which should not be bothersome. This small patch of persistent numbness is unavoidable, as removal of the neuroma requires removal of this small nerve.
Most patients are very happy with the result.
Revision Surgical Treatment
If you have already had surgery on a neuroma but your symptoms failed to improve, there are several possible reasons why. First, it is possible that the neuroma was misdiagnosed in the first place and that you have another pathology. Second, it is possible that part or all of the neuroma was left behind. Third, it is possible that the neuroma was removed but grew back.
Dr. Bohl specializes in revision neuroma surgery and correction of forefoot pain. While MRIs are not routinely needed prior to first-time neuroma surgery, Dr. Bohl may recommend an MRI if you have had surgery before. It is also important that you bring your operative report from the prior procedure. Please hand carry this to the clinic rather than having someone send it in.
No matter the cause of your persistent symptoms, Dr. Bohl will be able to offer a solution to help.