How to make treatment decisions for Morton’s neuroma management
My podiatrist says I need an operation to treat my Morton’s neuroma. What should I do now?
Morton’s neuroma is a common musculoskeletal condition that is characterized by moderate to severe pain and/or numbness in the forefoot due to compression of the plantar digital nerves. The most frequently reported sites of nerve compression are third and fourth inter-metatarsal spaces.
Even though it is called Morton’s neuroma, it is not really a neuroma and it’s not a tumor – it’s a nerve entrapment. It is important to understand that the pain and symptoms will generally progress and get worse if you do not treat it. A fair chunk of the population may also develop long term complications or some degree of disability due to untreated Morton’s neuroma. For example, it has been observed that a large number of chronic sufferers of Morton’s neuroma adopt abnormal gait to avoid pain and discomfort. Unfortunately, abnormal walking changes can directly pose pressure on other structures in your body and may aggravate the risk of arthritis, joint degeneration, stress fractures and other musculoskeletal injuries.
Do I always need Surgery for a Morton’s neuroma?
The prevalence of non-painful Morton’s neuroma in general population is about 30%(1) although one study reports it as high as 54%(2). This means that about one third to one half of the population is living with radiologically visible Morton’s neuroma. Does that mean all these folks should be treated?
The answer is a big No. That’s because, most neuromas are asymptomatic and are only identified incidentally on a radiological scan. So there is no need to do anything, unless you are experiencing foot pain or discomfort. If you are experiencing symptoms suggestive of a Morton’s neuroma, you should be evaluated by a clinical who is well experienced in diagnosing Mortons neuroma.
So when should I seek treatment for Morton’s neuroma?
Some indications for seeking treatment for Morton’s neuroma are:
- If you are experiencing moderate to severe foot pain that doesn’t get better with changes to your footwear or lifestyle modification.
- If your pain or discomfort is interfering with your quality of life.
- If you are developing gait issues or are experiencing other complications such as back pain, knee stiffness etc.
- If you are unable to sleep at night die to neuroma pain or if the symptoms are worsening with time.
In these cases, you should investigate what is causing your neuroma pain and seek the most appropriate non-surgical treatment.
We specialize in non-surgical procedures to treat Morton’s neuroma.
- Owens, R., Gougoulias, N., Guthrie, H., & Sakellariou, A. (2011). Mortons neuroma: Clinical testing and imaging in 76 feet, compared to a control group. Foot and Ankle Surgery, 17(3), 197-200.
- Symeonidis, P. D., Iselin, L. D., Simmons, N., Fowler, S., Dracopoulos, G., & Stavrou, P. (2012). Prevalence of interdigital nerve enlargements (Morton neuroma) in an asymptomatic population. Foot & ankle international, 33(7), 543-547.
Janet D. Pearl, MD, MSc is the Medical Director of The Center for Morton’s Neuroma and Complete Spine and Pain Care, an interventional and integrated Pain Management program located in Framingham, Massachusetts. Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Fellowship program. She is the former Director of a satellite pain center of the Brigham and Women’s Hospital, Pain Management Center, located at the HealthSouth Braintree Rehabilitation Hospital. Dr. Pearl held academic appointments at Harvard Medical School and Tufts Medical School. She serves on the Health Care Services Board of the Commonwealth of Massachusetts Department of Industrial Accidents since 2000 as one of its physician representatives and is Chair of the Committee on Pain Management.