Treatment Options for Neuromas

'Morton's neuroma' (also known as Morton's metatarsalgia, Morton's neuralgia, plantar neuroma and intermetatarsal neuroma') is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the third and fourth intermetatarsal spaces.
This problem is characterised by numbness and pain, relieved by removing footwear and is commonly described by my patients as "feeling like walking on a bunched up sock".




It's not really a neuroma. Adding the Greek suffix "-oma" to a word literally means "tumour". That's why we attach it to words referring to cancerous conditions like lymphomas and benign tumours like fibromas.
A neuroma is not really a tumour at all. It's actually a growth of scar tissue around a nerve, due to chronic irritation. Instead of our using the word "neuroma", the more proper name for the condition would be "perineural fibrosis", which literally translates to "scar tissue around the nerve".

What are my options for treatment at FFLC?

Here at our center we try to avoid any surgical excision by performing various treatments which are minimally invasive, safe, and proven to be effective.

We typically offer several options, one being serial injections of a sclerosing alcohol mixture to dull the painful lesion and ultimately reduce the frequency and severity of the pain experienced. This is a weekly event, which may take up to 10 injections (effectively treating the lesion within 3 months time and avoiding surgery). We have had great success with the injections, and the are very beneficial for patients who are otherwise not great surgical candidates (especially patients with other medical problems which carry higher risk for surgery). Occasionally we use our ultrasound device to pinpoint our injection more accurately, to thereby target the nerve lesion with improved results in more difficult cases.

Another option is cryosurgery. This is illustrated on our Youtube channel. This is a small "stab" incision which is placed between the digits which are on either side of the pain. Then we use the ultrasound machine to visualize the placement of the cryoprobe. Our assistants hold the probe still while it delivers subzero temperature at a pinpoint location which we can see on the small screen. It is done in the office, and with minimal risk. Patients do well with this modality, and leave without a stitch. They follow up with us weekly until the wound is closed, and they are relatively pain free from that time foward.

This is the most common area of symptoms in a neuroma.

We advise patients that no surgery or technique is perfect, and must let you know that a possiblity of recurrence, pain, numbness, and infection are unlikely but known complications. And we reserve open excision for patients with large bulbous neuromas which are either palpated easily in a clinical setting, or visualized well on advanced imaging such as MRI. The large lesions, as well as revisional surgeries may require more invasive surgery but this is not the majority of cases by any means.

When you have finished the treatment course for neuroma ablation/excision, you will feel a numb sensation between the toes which the lesion was found. This is the most common complication, but it is not a true complication. Especially when that area was previously painful and quite problematic while walking.