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.
How to Successfully Treat an Intermetatarsal Neuroma Without Surgical Removal:
1. 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. It may not improve any numbness that may already have occurred.
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.
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 usually repeated as needed, a clear disadvantage of RFA. However, patients usually experience pain relief much faster with cryo, an advantage over RFA.
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.
4. Decompression Procedure:
This technique is used when preservation of the nerve function (sensation) is desired. 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.
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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.
Revision neuroma surgery with muscle implantation is a very successful technique. click here to request a consultation.
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. We guarantee that you will be satisfied with the custom orthotic or you can return it for a refund (per the agreement/policy you signed).
Injections, but not into the nerve, can be very helpful. This needs to be done under the guidance of an ultrasound. This is performed in our office routinely. Relief may last for many years or be only temporary.
Why a Morton's Neuroma Is Not Really a Neuroma:
This can happen when the nerves that are under the ball of the foot get pinched, compressed or entrapped. The nerves to the toes can become pinched, compressed, or entrapped between the bones and underneath a ligament that connects the bones. 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 nerves.
This interdigital nerve compression is widely erroneously referred to as a neuroma, which means a truly damaged nerve. 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.