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10 Signs you may have Morton’s neuroma

Do you have foot pain or metatarsalgia? What are the 10 signs that you may have Morton’s neuroma? We specialize in treating Morton’s neuroma.

Alcohol sclerosing injections Vs Alcohol neurolytic injections

Alcohol sclerosing Vs Alcohol neurolytic injections for Morton’s neuroma We discuss the difference and importance. We specialize in treating Mortons neuroma

What shoes should I wear for Morton’s neuroma?

We are often asked what shoes should I get for my Morton’s neuroma? Shoes are critical in preventing and treating Morton’s neuroma.Our recommendations are..

What conditions mimic Morton’s neuroma?

Morton’s neuroma often mimics other musculoskeletal and neurological conditions of the foot, which makes it quite challenging to accurately diagnose.

Morton’s neuroma (also referred to as metatarsalgia) is a chronic and painful condition of forefoot resulting in varying degrees of disability and compromised quality of life.

Most patients seek immediate medical help. After a course of conservative treatment and perhaps a corticosteroid steroid injection, most patients are offered the option of surgery for Morton’s neuroma. Do you really need surgery? Is so when?

Do I Need Surgical Intervention For Morton Neuroma management?

Morton's Neuroma Surgery

There is no urgent need for surgery because Morton’s neuroma is not a tumor or malignant lesion. However, if you are experiencing pain, discomfort, numbness or a pin and needles or tingling feelings in your foot, several non- surgical options must be considered before surgery.

Most importantly, your diagnosis of Morton’s neuroma must be accurate and correct before you consider any procedures or surgery. In other words you should know that you have a Morton’s neuroma and that your Morton’s neuroma is the cause of your foot pain. For information on the diagnosis of Morton’s neuroma see here.

Ideal Treatment Options For Morton’s Neuroma:

In clinical practice, surgical removal of your Morton’s neuroma is the least preferred treatment for Morton’s neuroma and should be only performed after all other non-surgical procedures have been tried.

We recommend the following non-surgical procedures before surgery:

It is important to consider that some individuals (those with long complex histories or who have had numerous procedures,) may sometimes require more than one sessions of radiofrequency  or cryosurgery (depending upon the site and severity of your Morton’s  neuroma) to induce complete resolution of symptoms. However when done by experienced providers, these ultrasound guided procedures are safe and very effective.

Surgical Intervention For The Treatment of Morton’s neuroma:

Surgical intervention is usually reserved as a last resort; when no other therapeutic solution works. For example, when you have had multiple interventional procedures under ultrasound guidance and your pain is still present and irritating you or even getting worse.  At that point, it may be important to have your doctor double check your diagnosis before surgery and possibly have an MRI to exclude other conditions that may mimic Morton’s neuroma.

Most healthcare providers avoid Morton’s neuroma surgery because:

Morton's Neuroma Surgery
  • The success rate of surgery is around 70% at best(1);
  • The rate of complications is fairly high. For example, more than 72% patients develop permanent numbness (or loss of sensations) in the area of involvement. Other common complications include; painful scar formation, neuroma stump formation, infection and other ailments(2);
  • A fair percentage of surgical patients experience recurrence of neuroma after surgery (at a different site or in the vicinity); and,
  • The return to normal day-to-day activities can take months after surgery.  On the other hand, the return to activity is very short with most ultrasound-guided procedures.

In summary, based on the latest data and clinical estimates, lifestyle modification and the ultrasound guided minimally invasive procedures listed above are highly effective in resolving most cases of Morton neuroma. Surgery should be left as a last resort.

References:

  1. Chuter, G. S., Chua, Y. P., Connell, D. A., & Blackney, M. C. (2013). Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skeletal radiology, 42(1), 107-111.
  2. Kasparek, M., & Schneider, W. (2013). Surgical treatment of Morton’s neuroma: clinical results after open excision. International orthopaedics, 37(9), 1857-1861.

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