Clinical Presentaion: Morton’s Neuroma is a Progressive Condition
My first experience treating Morton’s Neuroma was as a surgical resident, although an extensive history was available, very little follow-up of these patients was available. Histories taken from these hospital based patients, who where all scheduled for surgery, included long term disabling pain associated with weight bearing activity, in spite of a variety of DIY and medical treatments attempted.
Many patients had multiple neuromas often in both feet. A high percentage of these long term sufferers had a history of previous foot surgery including Bunion surgery, Hammertoe surgery, and even previous Morton’s Neuroma surgery.
As I started private practice I started to see a more complete range of Morton’s neuroma patients. It became apparent that symptoms in the early stages of this condition, were very different from the symptoms reported in the middle and end stages of this progressive condition. Conservative treatments observed to be helpful in the early stages, had minimal benefit to patients in the later stages of this progressive condition.
It did not take long for me to realize that I had no effective long term conservative treatment for Morton’s Neuroma. A very high percentage of patients in the middle and late stages of this conditions went on to surgical excision. For years surgery was the only answer I had.
Over time it became apparent that even surgery was not an effective long term treatment for Morton’s Neuroma. After observing hundreds of surgical patients, even when the procedure goes perfectly short term, it usually fails long term. Patients often grow MORE neuromas in both feet. Because the progression of this condition is related to patient activity, active patients progress more rapidly compared to those who diminish their activities to control the painful symptoms.
Early Middle and Late stages of Morton’s Neuroma
- Early: In the beginning of Morton’s Neuroma condition, the patients reports more of an annoyance and not so much of a pain. The patients often describes the feeling as a bunched up sock under the 2nd and 3rt metatarsals . They generally describe a numbness or buzzing sensation between the metatarsals that can be associated with specific weight bearing activity.
- Middle: In the middle stage of Morton’s Neuroma, the symptoms are no longer an annoyance but rather sharp intermittent pain associate with excessive activity on their feet. In this stage the characteristic sharp shooting electrical or burning pain is described. The pain is generally intermittent in the middle stages of the condition. Patients report that only after they spend too much time on their feet does the pain begin. Patients begin to seek medical help and decrease regular activities they normally do.
- Late: As Morton’s Neuroma progresses the pain is present during most all weight bearing activity. In the late stage it is common to have multiple neuromas in both feet. The now constant pain is electrical and burning in nature and definitely aggravated by any weight bearing activity. Some symptoms can remain even when the patient is non-weight bearing. The only way patients learn to stop the pain in the final stage of Morton’s Neuroma, is to curtail virtually all weight bearing activity.
Morton’s Neuroma: A progressive condition caused by the way we walk.
Because the 2nd and 3rd inter-metatarsal nerves are traumatized every time we stand, walk and for a few run, the real cause of neuromas persists, even when adequate surgical resection is accomplished. As a result the progression of this condition, over time, frequently results in other gait related medical conditions. It should be noted that multiple neuromas in both feet are frequently reported. It was not uncommon for a surgical patient to report symptoms of a new neuroma before they got the bandages off from the first surgery.
To be fair, there were several neuroma patients who posted good long term surgical results, in response to my last blog post about DIY treatments.
I do acknowledge that a well performed surgical excision can work up to a point. Generally surgical patients who do report long term success without reoccurrence or generation of new neuromas, are those who significantly modify their life style to control the progression of this gait related condition. Patients who have observed what they thought was a permanent resolution with a variety of treatments including surgery, are very discouraged and soon become desperate, when symptoms of the same or another neuroma present, sometimes even 20 years later.
All of the treatments for Morton’s Neuroma, both conservative and surgical can absolutely help, and occasionally they may even appear to permanently resolve this progressive problem. Unfortunately when the majority of patients are observed long term, it becomes apparent that the only patients who successfully arrest the progressive nature of this disabling condition are those who continually eliminate more and more of the weight bearing activity that is causative.
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