How does Morton’s Neuroma present?
This progressively disabling condition is known to cause intense pain that feels like a bad tooth ache in the foot. Even patients who might never go to the doctor, are forced to explore any and all available Morton’s Neuroma treatment options. It soon becomes obvious that every step we take creates a grinding motion that inflames the nerves, resulting in numbness, burning, and electrical sensations. Morton’s neuromas are usually located in the 2nd and 3rd inter-metatarsal spaces. As the condition progresses, it often involves both feet, with multiple neuromas being reported.
Conservative and invasive treatment for Morton’s Neuroma.
There are many pro’s and con’s for all of the conservative and surgical treatments mentioned below. Many physicians are quick to recommend surgery for treatment of Morton’s Neuroma, and often patients are quick to accept surgery after trying a few of the conservative treatment options. One of the only conservative treatments that consistently provides a little help to about half of the patients who try it, is a metatarsal arch pad. Unfortunately it only provides just a small portion of the help that is necessary.
Failed Morton’s Neuroma treatment creates desperation.
Often patients call after years of pain with a list of failed treatments and physicians. Most every one of the 14 thousand Morton’s Neuroma patients that have requested my help over the last 30 years, have expressed the desperation that motivates them to seek help from any source, including me. Although Morton’s Neuroma patients are desperate for help, their long term history of failed treatments, cause them to be even more skeptical that anyone can help.
Morton’s Neuroma Treatment Options
1. Steroid Injections
Cortisone injections into the Morton’s Neuroma are often the first line of treatment recommended by physicians. Often a significant reduction in pain is temporarily observed immediately following the injection. Although a relatively safe treatment, rare reactions are observed, possibly more related to the anesthetic used in combination. Generally every time the injection is given it becomes less effective and the duration of benefits is decreased. Because cortisone injections only mask the inflammation and pain, they are rarely if ever, a permanent option in the treatment of Morton’s Neruoma.
Anti-Inflammatory medication can be helpful in the early stages of this progressive condition, but falls way short of the help required as it advances over time. Prednisone dose packs can also provide noticeable relief even in moderate to advance cases. Unfortunately inflammation is created with every step we take, so greater amounts of medication are eventually required with diminished benefits. Even oral narcotics won’t control the pain when this condition is in the advanced stages. All of the common side effects of pain meds often only complicate the problem.
3. Physical therapy
Because many physical therapy modalities will help reduce inflammation they can be a very helpful treatment option for Morton’s Neuroma. Because PT does not treat the cause of the inflammation, that occurs as we walk, more and more frequent treatments are necessary with diminishing results. Time and cost restrains are associated with this treatment option that will provide only minimal and temporary benefits.
Most physicians understand that walking activity somehow aggravates the Morton’s Neuroma condition. They know that orthotics can change the way we walk, and are frequently used to treat other conditions also believed to be caused or aggravated by the way we walk. In spite of this understanding only about half of the foot specialists recommend orthotics as a treatment option for Morton’s Neuroma. Your specialist knows that the orthotics they prescribe are generally an out of pocket expense to the patient, and that they are not a good treatment option for Morton’s Neuroma anyway, because they just don’t work. If they do help for a while, relief is usually minimal and temporary. Many doctors recommend orthotics in spite of the fact that they rarely work long term, because they understand that the only alternative is surgery, and they want to exhaust all conservative options first.
5. Alcohol Injections
Over the last 25 years foot specialists have desperately searched for another effective alternative before surgery. A series of injections containing a toxic chemical that can kill nerve tissue was thought to be less invasive than surgery yet kill the nerve and stop the pain. This treatment is an unpredictable attempt to ablate the inter-metatarsal nerve, and stop the pain. There is minimal to no guarantee that after as many as 10 painful injections, any or all of the nerve will me ablated. What is also not clear is how much damage to the good tissue is being done by this toxic chemical. From both my personal experience using this treatment and consultation with many patients who have experienced this treatment, I fail to see any long term value. I do see definite potential for toxic tissue reactions associated with the application of this treatment. I definitely know that it is more difficult for me to treat a Morton’s Neuroma patient once they have had a series of failed OH injections.
6. Surgery (Ablative Procedures)
Surgical excision is the most definitive ablative treatment option for Morton’s Neuroma. Radio-frequency ablation and Cyro-ablative procedures are newer alternatives to surgical excision. Pros and cons for all ablative procedures are debatable. Short and long term benefits of all ablative procedures are not well documented. What is certain is that even if the ablative procedure used by your surgeon WORKS PERFECTLY, overall and long term it will fail.
The cause of the problem that occurs as we walk, has not been addressed with surgery, just excised or ablated. The big con of surgery is that you will likely grow more neuromas over time. Experience tells me that patients get more neuromas soon after they get the first, and that they are not so desperate as to consent to surgery again as their Morton’s Neuroma treatment option of choice.
Unfortunately I have found that none of the Morton’s Neuroma treatment options listed above can totally resolve the progressive pain associated with this condition. For more information about how Theta Orthotics can help you manage your MN pain, click here.
Brent Jarrett DPM