Morton's neuroma and metatarsalgia sneakers
What sneakers are best for pain in the forefoot?
There are several common disoders that can cause pain under the ball of the foot when walking; i.e. Morton's neuroma, plantar plate degeneration and tears, bursitis, capsulitis, arthritis, etc.
When it comes to sneakers, first and foremost the shape of the toebox needs to match the shape of your forefoot. Take out the insole of the sneaker and place your foot on it, centered as best as possible. Can you see the insole around your toes when you stand on it with full weight? If not the toebox is too narrow for you, resize or choose another model.
What about heel height? Should there be a zero drop? Should there be a 6 mm drop? The answer is different for each individual and depends on findings of your physical exam. If you have normal ankle range of motion, then a zero frop may be helpful. However, many patients have a mild limitiation of ankle extension, which is identified on a detailed physical examination. The limitation may be subtle, but if there is a limitation, a heel to toe drop of 4 to 6 mm would usually be more helpful.
Unfortunately, a particular model sneaker may work for one person but not another, even for the same condition. This is due to each individual foot structure. Therefore, recommendations for a brand and model are beyond the limitations of this post. Your strucural abnormalities can be discovered on a detailed physical examination. In addition, a computer assisted gait (walking) analysis may be of additional value.
Most importantly, depending on your foot structure, it may be even more important to use a molded custom foot orthotic with modifications to improve your foot function.
How to Successfully Treat a Morton's Neuroma Without Getting a Stump Neuroma:
1. Nerve Decompression:
This technique is used when preservation of the nerve function (sensation) is desired. A "stump neuroma" is not possible to occurr with this procedure. This procedure is best for neuromas that have not had any attempt at prior surgery or destructive treatments (chemical alcohol or other ablations). The procedure is usually about 30 minutes and you can walk the same day. A small incision is placed on the top of the foot and the tight bands that bind down the neuroma are released. The neuroma is "un-pinched". This can be done minimally invasive using an endoscope (the size of a pencil). Only mild sedation and a local anesthetic are required. Most patients return to sneakers at the 4th week after surgery. Numbness and tingling may improve if nerve damage is not advanced. This procedure is effective in men more than women, due to differences in heel height that places more weight on the forefoot.
2. Radiofrequency Ablation
Since 2010, we have been utilizing ultrasound-guided radiofrequency ablation (RFA). Ultrasound-guided RFA is a minimally invasive procedure that uses high-frequency sound waves to heat the sensory nerve/neuroma. Once heated, the nerve no longer effectively transmits pain sensation. The nerve is destroyed and usually offers long-term results and high patient satisfaction. However, sometimes more than one treatment is required. It may not improve any numbness that may already have occurred. It is best applied to neuromas that already failed decompression or alcohol or stump neuromas.
The procedure is minimally invasive and is performed under local anesthesia. Outcomes are optimized using ultrasound imaging and nerve stimulation to ensure correct positioning. Occasionally the RFA may need to be repeated for best results. A stump neuroma is not possible with this treatment
Ultrasound-guided cryosurgery (also known as cryoablation) generates extremely cold temperature to destroy neuroma tissue. We use ultrasound guidance to increase the effectiveness of this treatment by ensuring the correct placement of the probe tip. This procedure is sometimes repeated if needed. A stump neuroma is not possible with this procedure.
3. PRP (Platelet Rich Plasma)
Platelet-rich plasma (PRP) treatment is the injection of the patient’s own platelets to treat Morton’s neuroma. It is used for other disorders, such as of injured tendons, ligaments, muscles, joints.
Ultrasound imaging is used to guide the injection and this increases the accuracy of the PRP procedure. Occasionally, additional injections may be needed. There is not enough data to clearly state this treatment is effective by itself or when combined with other treatments.
Did you already have neuroma surgery, but are worse now?
Don't worry, even if you already had your neuroma removed and still have pain there is hope for pain relief. Radiofrequency and cryoablation may be helpful but will require more than one treatment due to dense scar tissue that usually forms around a stump neuroma.
When should I remove my Morton's Neuroma?
10% of Morton's Neuroma do not improve with the above treatments and surgical removal is sometimes needed
Neuroma surgery to remove the Morton's Neuroma (aka neurectomy) with muscle implantation is a successful technique. There may be less risk for a stump neuroma with this technique. If needed, this could be performed from the top of the foot or the bottom, depending on your circumstances, anatomy, and prior treatments. Request an appointment with Dr. Rockmore
Other Non-Surgical Treatment:
Custom Molded Foot Orthotics can help reduce pressure on the nerve. We use a computer to analyze the movement of your foot to detect abnormalities and to fabricate a superior orthotic.
Injections, but not into the nerve, can be very helpful. For best results, administer under the guidance of an ultrasound. Ultrasound guidance has shown to be more effective than blind injections. This is performed in our office routinely. Relief may last for many years or be only temporary.
Did You Know That a Morton's Neuroma Is Not Really a Neuroma? You need to know this to treat it ....
The nerves that are under the ball of the foot are under a lot of weight and they can get pinched, compressed or entrapped. The nerves to the toes can become pinched, compressed, or entrapped between the bones and underneath a ligament that travels across the toe joint. If the nerve is entrapped long enough, it will swell and enlarge, making the nerve even more vulnerable to pressure and increased pain symptoms. Our job is to reduce the pressure on the nerve, similar to how carpal tunnel release helps carpal tunnel syndrome.
This interdigital nerve compression is widely erroneously referred to as a neuroma. A neuroma is defined as a damaged nerve. Many neuromas are found at amputation sites and areas where a nerve suffered a traumatic injury. What is happening in the foot is usually not a damaged nerve, rather it is a compressed nerve. The difference is huge because compressed nerves require a simple procedure called decompression (neurolysis). The treatment for a true neuroma is to cut out the neuroma. Cutting a nerve usually leads to sensory loss and the possibility of a very painful stump that would require additional surgery. The treatment for a compressed nerve is to decompress it and give it room to move around inside the foot, a much less risky procedure that usually improves the sensation in the toes and alleviates the pain.
Your Symptoms Are:
- Pain and throbbing on the ball of the foot.
- Sharp pain that shoots into the toe.
- Some patients feel as though their sock is bunched up under their foot, yet it is not. Others feel as though there is a stone stuck in their shoe. Often times there may be numbness.
You may also have tarsal tunnel syndrome and that needs to be determined and treated for successful neuroma treatment. If you have symptoms in both feet, you may also have a peripheral neuropathy. We offer painless nerve testing with the Pressure Specified Sensory Device to determine if there is an underlying peripheral neuropathy or tarsal tunnel syndrome in addition to the neuroma.