Morton's Neuroma Pain in Foot - Surgical Excision

Resources Consultant: Kelly Powers
Producer: Nicholas Giovinco

A Morton's neuroma is a pathological condition which is caused by a benign neoplasm of the plantar interdigital nerve in the foot. This results from a tumorous growth of the perineurial tissue called a fibroma, thus a Morton's neuroma is not a true neuroma.

Although a Morton's neuroma most commonly arises in the 3rd interspace, between the 3rd and 4th metatarsal heads, it may also be found in the 2nd or 4th interspace as well.

Symptoms of a Morton's neuroma may include numbness, paraesthesia, and a sharp, shooting pain, which radiates towards the affected toes. This sensation is elicited or exaggerated by compressing the metatarsal heads together which, in turn, compresses the enlarged nervous structure.

Conservative care of a Morton's neuroma may include sclerosing and anti-inflamatory injections, as well accommodative orthosis. Although these methods may relieve painful and immobilizing neuroma conditions, surgical intervention may be required.

This involves soft tissue exposure or dissection of the enlarged nerve body. Once this is done, the neuroma must be isolated and removed by cutting away the stem, proximally, and the branches, distally.

Because the nerve is removed, there will be a loss of sensation in the affected area for several months or even years. Over time, this area will re-innervate by means of communicating branches from surrounding nerves.

Category:

Education

Tags:

• Podiatry
• Podiatric
• Surgery
• Morton
• Hauser
• Iselin
• Neuroma
• Fibroma
• Fibrosis
• Neural
• Peri
• Excision
• Injection
• Foot
• Toe
• Pain
• Nerve
• Nervous
• Tissue
• Steroid
• Inter
• space
• metatarsal
• radiate
• radiation
• Dissection
• discomfort
• shoot
• shooting
• heuter
• removal
• tumor

[eviljoebob]

Im trying to figure out if I might have this or a stress fracture. I run and got a stress fracture on my right foot about 3 weeks ago and the past few days I've had a weird throbbing feeling in my left foot either on my 4th metatarsal or between the 4th and 5th metatarsals

[DrGlassDPM]

@eviljoebob Injury and inflammation, especially after a long time, can present with a wider range of symptoms. Have you received any recent Xrays? Stress fractures will have a maximal point of tenderness on the bone itself, but they are not always easy to localize...

[porksniffer]

Ugh...Thanks for the video. I think this is what I have. I'm a runner of 12 marathons and run 50miles/week. The pain is is on my left foot, 3rd toe on the inside part close to the 2nd toe. It's a radiating shooting pain like a shock and doesn't happen on every single step. Almost as if it takes a few steps break, then shoots for a few steps, stops. It is excruciating. I have stopped running, since it is impossible. Will this go away with rest, ice and anti inflams or am I dreaming?

[DrGlassDPM]

@porksniffer Often, injections will help this. Sometimes an irritated or inflamed nerve will cause those sorts of uncomfortable symptoms.  Have you received any injections?

[JonathonPetruk]

haha thumbs up if datsik and excision brought you here :P

[BecauseiBactracedit]

I CLICKED THIS CAUSE IT SAID EXCISION. HOPING FOR MIND BLOWING MUSIC, I GET EDUCATION?! BLAH!

[bboyjkang]

Hey Dr. Glass. Do you have any opinions on cryosurgery to treat a morton’s neuroma? (ABC news story: watch?v=jE0r27vYNDQ). Only a handful of podiatrists in the states use the cryostar machine and procedure. I think only 1 podiatrist in British Columbia, and all of Canada (where I’m at) recently obtained the cryostar machine. It’s minimally invasive, and supposedly has high success rates. Promising?

[porksniffer]

@DrGlassDPM No, haven't gone the injection route just yet. I've managed to heal it somewhat by using an insole with about a 1cm moleskin padding just under and behind my big toe. It's taken the pressure off the neuroma and has allowed me to resume running for less than an hour. It's been getting progressively better albeit very slowly but the pain is still there when walking barefoot. Your video was very helpful with the diagnosis. Thank you.

[kantire]

@DrGlassDPM All I have done since then is I bought custom made orthodics, I'm wearing the best running shoes I can afford, I have taken a desk job to stay off my feet. My doctor has basically said" whats done is done" in regards to my surgery- you can't undo whats done. I just want people to search out all other means before considering surgery. As I said you can't undo what's been done.

[DrGlassDPM]

@kantire I imagine 4 years is a long time to deal with the pain; my sympathy to you. What other treatments have you tried?

[kantire]

@DrGlassDPM My surgery was 4 years ago-and I still cannot feel my toes, My other foot also has a neuroma but I'd rather live with that pain than undergo the surgery again.

[DrGlassDPM]

@kantire I'm sorry to hear your situation. Nerve surgery can have some variable results. How long ago was your procedure?