Other treatments for Morton’s neuroma
Other modalities of treatment for Morton’s neuroma
Morton’s neuroma is a fairly common musculoskeletal condition that is characterized by pain in the foot. In most cases, the pain and resulting disability can interfere with day-to-day activities and cause other problems. The primary cause of Morton’s neuroma is a nerve entrapment usually between the 3rd and 4thtoe resulting in fibrosis or thickening of the nerve due to persistent pressure or stress. Morton’s neuroma is more common in females as compared to males due to peculiar anatomical and physiological architecture/ alignment of the female foot.
Physical Therapy and Morton Neuroma
Most musculoskeletal conditions involving upper or lower limb responds fairly well to physical therapy. Physical therapy improves the circulation and natural healing processes that aid in early recovery. Unfortunately, there is little scientific evidence regarding the efficacy of physical therapy in the treatment of Morton’s neuroma.
Physical Therapy is often supplemented by other modalities. These are:
Therapeutic Ultrasound is a therapeutic modality that has been used by physical therapists since the 1940s. Ultrasound is applied using a round-headed wand or probe that is put in direct contact with the patient’s skin. The sound waves that pass through the skin cause a vibration of the local tissues. This vibration or cavitation can cause a deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, such as a fresh injury with acute inflammation, the ultrasound can be pulsed rather than continuously transmitted. Therapeutic Ultrasound does not have any effect on Morton’s neuroma and is generally not used in Morton’s neuroma.
Recently, Low Level Laser Therapy (like MLS) is being used to treat muscular and joint pain. This is also referred to as “Cold” laser therapy because it uses low levels of light to treat areas of the body that have been injured, or more accurately damaged in some way. Unlike the very high-powered lasers sometimes used in health care to cut tissue, cold therapy lasers produce photochemical and photobiological interactions that can repair injured or damaged tissue. However, there has been no published study on the use of cold laser therapy in Morton’s neuroma. In fact, there is no study of any kind of laser use in Morton’s neuroma (aside from lasers used in surgery.)
Transcutaneous electrical nerve stimulation
TENS (Transcutaneous electrical nerve stimulation) is an effective treatment for muscular pain whereby electrodes are placed on or near the area of pain and soothing pulses are sent via the electrodes through the skin and along the nerve fibers. The pulses (controlled by the user at all times) suppress pain signals to the brain. T.E.N.S. also encourages the body to produce higher levels of its own natural pain killing chemicalscalled Endorphins and Encephalin. Not only does T.E.N.S. help relieve pain, but the sensation felt is very pleasant and soothing and is totally controlled by the user. TENS is more commonly used in muscular and sometimes joint pain and is rarely if ever used for Morton’s neuroma.
Unfortunately, despite the promise of these treatments, none of them have shown to have any effect on Morton’s neuroma. Morton’s neuroma is a unique type of entrapment neuropathy. The nerve leading to your web space in your foot undergoes a mechanical and vascular entrapment as it passes between the metatarsal heads. It usually occurs in between the 3rd and 4th metatarsal heads but can occur elsewhere. There have been no studies that demonstrate any conclusive effectiveness of any of the above therapies Morton’s neuroma. Therapies such as those above, are used in cases of muscular or joint pain, in conjunction with physical therapy. They are all ineffective in dealing with a nerve entrapment syndrome such as Morton’s neuroma.
Morton’s neuroma is a complex condition that can be difficult to diagnose and difficult to treat. The exact pathophysiology of Morton’s neuroma is still unclear. Morton’s neuroma should be treated by a clinician who has significant experience in treating Mortons neuroma.
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.