Neuroma and Nerve Problems

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Article by Dr. Misako McLeod, DPM

What is a Morton’s Neuroma? Many people have heard of this term and it’s a pretty common issue. A neuroma is basically a nerve anywhere in the body that is inflamed (neuritis), or so inflamed that it is beginning to form scar tissue (fibrosis). A common area is in the foot due to the fact that the constant pounding due to walking and weight bearing causing trauma and irritation to the nerve. This causes the nerve to become inflamed and, at times, scarred (fibrosis) and enlarged. Sometimes the nerve becomes so enlarged, that your practitioner can be a palpable “click” on physical exam. This is called a “Mulder’s click” and is indicative of a neuroma.

So, what are the treatments? When Dr. McLeod diagnoses a neuroma, the first question is why did the patient develop one n the first place? Dr. McLeod will perform a non-weightbearing and weight bearing exam to evaluate your mechanics. Next, x-rays be performed to screen for any soft tissue abnormalities and anything more serious such as sift tissue tumor, which is unlikely. Then, nonsurgical treatment such as steroid injections, physical therapy, and stretching the calf to offload the front of the foot will be recommended.

If non-surgical therapy doesn’t improve the symptoms, then surgical excision is an option. Due to the fact that the nerve will be removed, there will be permanent numbness in between the toes. However, this numbness is usually non-painful and patients “forget” that there is numbness there.

Neuroma surgery is an outpatient surgery and takes about 30 minutes. A local anesthetic block will be performed to control your pain and you will be released home after surgery with appropriate pain medication.

It’s important to be evaluated by a foot and ankle specialist to get an proper diagnosis. Plantar plate ruptures are often misdiagnosed as neuroma by non-speciality trained practitioners.

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