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Morton's Neuroma Surgery: A Minimally Invasive Approach

What Is a Neuroma?

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common place for a neuroma in the foot is a "Morton’s neuroma", which occurs between the third and fourth toes on the bottom of the ball of the foot. It is sometimes referred to as an inter-metatarsal neuroma, meaning "between the metatarsals". The metatarsal bones are located behind the bases of the toes. Neuromas may also occur in other locations in the foot, especially between other metatarsals.

This thickening, or enlargement, of the nerve that defines a neuroma is usually the result of compression and irritation of the nerve in that area. This compression creates the enlargement of the nerve, and can cause numbness, tingling, and pain; eventually leading to permanent nerve damage.

Causes of Neuromas

Anything that causes compression or irritation of a nerve can lead to the development of neuromas. One of the most common reasons is wearing shoes that have a narrow toe box, or high-heeled shoes that cause the toes to be forced or jammed into the toe box.

People with certain foot deformities such as bunions, hammertoes, flat feet, or hyper mobile flexible feet are at higher risk for developing neuromas. Other potential causes can be activities that involve repetitive irritation to the ball of the foot, such as running or other sports like tennis. An injury or some other type of trauma to the area may also lead to development of a neuroma.

Neuroma Symptoms

If you have a Morton’s neuroma, you may have one or more of these symptoms where the nerve damage is occurring in your foot:

  • Numbness, tingling, or burning

  • Pain

  • A feeling that something is inside the ball of the foot

  • A feeling that there’s a "pebble" or something in the shoe

The progression of a neuroma often follows this type of pattern:

  • The symptoms usually begin gradually. At first they occur occasionally, when wearing narrow-toed shoes or performing certain aggravating activities or movements.

  • The symptoms may go away temporarily by removing or changing the shoe or insert, massaging the foot, or by avoiding aggravating activities.

  • Over time, these symptoms can progressively worsen and may persist for several days or weeks, or longer.

  • The symptoms can become more intense as the neuroma enlarges and the temporary changes in the nerve become more permanent.

Diagnosis of Neuroma

To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests or imaging studies may be performed.

The best time to see your foot and ankle surgeon is early in the development of symptoms. Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may avoid surgery.

Non-surgical Treatment for Neuromas

In developing a treatment plan, your foot and ankle surgeon will usually first determine how long you’ve had the neuroma and evaluate the stage of development, usually with an ultrasound or MRI. Treatment approaches may vary according to the severity of the problem. For mild to moderate neuromas, various non-surgical treatment options may be included, but are not always helpful.

When Is Surgery Needed?

Outpatient or office surgery may be considered in those patients who have not responded adequately to non-surgical treatments. Your foot and ankle surgeon will determine the approach that is best for you and your condition. The length of the recovery period will vary, depending on the procedure performed. There are a few different procedures that are available that your surgeon will discuss with you and determine which would be the best procedure for you. There are minimally-invasive surgeries that can be performed with small incisions and usually no visible scarring. Sometimes surgery can be performed endoscopically with a small camera. Your surgeon must evaluate you to determine if a simple nerve decompression, repositioning of the bones, or removal of the neuroma is necessary. Doctor Daniel Pero, DPM, can perform all of these procedures in the outpatient or office setting with minimally-invasive techniques which enable an early return to your normal activities.

Regardless of whether you have undergone a surgical or nonsurgical treatment, your surgeon will usually recommend long-term measures to help keep your symptoms from returning. These may include appropriate footwear or orthotics to reduce the repetitive pressure on the ball of the foot.

Doctor Pero has podiatry office and foot and ankle surgery clinic locations in several South Florida areas. Call now for an appointment at (561) 293-3439.

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