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How do I heal a neuroma?

The term neuroma implies a painful, benign tumor of a nerve. Many people mistakenly use the term neuroma to refer to a painful, burning sensation in the forefoot (part of the foot towards the toes). In most cases the burning pain is a result of pressure on the sensory nerves coming from the toes. The pressure is usually caused by a combination of swelling in the metatarsal phalangeal joints (toe joints) and compression of the foot in footwear. The swelling in the metatarsal phalangeal joints is caused by overload of the metatarsal heads (ball of the foot). The shape of one’s foot, poor running mechanics, or muscular imbalances such as tight calf muscles or toe extensor recruitment may cause overload of the metatarsal heads.

To heal a neuroma you have only to alleviate the forefoot pressure causing the pain in the first place. A well-cushioned shoe of the type correct for your foot (see my article How do I pick a good running shoe?) can help considerably. A custom foot orthotic or shoe insert may also help to alleviate pressure. Anti-inflammatory medications may help to alleviate pain and swelling in the joints, and thereby, eliminate neuroma pain. Many patients ask about cortisone injections for neuroma pain. I do not recommend cortisone injections because they can cause atrophy of the skin and the necessary padding in the forefoot.

Traditional surgical treatments have focused excision of the inflamed nerve. This creates numbness in the toes, but because the pressure has not been alleviated, neuroma pain may persist. I prefer surgical treatments that decrease pressure on the forefoot. Usually this is a procedure to lengthen a tight calf muscle alone or in combination with a procedure to change the bony anatomy of the forefoot. When non-operative treatments have failed, calf-lengthening procedures have been successful in treating “neuroma” pain in nearly 95% of patients. Calf-lengthening has even been successful in patients who have had previous neuroma surgery.

by Dr. Jeff Rocco – Orthopedic Surgeon | Specializing Foot and Ankle Reconstruction, and Lower Extremity Trauma

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This entry was posted on Thursday, April 22nd, 2010 at 10:17 am and is filed under Injuries and Pain, Running Shoes, Sports Medicine. You can follow any responses to this entry through the RSS 2.0 feed.

5 responses to “How do I heal a neuroma?”

  1. Carol Campbell says:

    I fought with a neuroma for several years. I had special inserts that took the pressure off it (worked a little)and had injections. The injections worked really well but of course don’t last forever. My best remedy was a great doctor, surgery, and 3 weeks off for recovery.

  2. Lisha Russell says:

    Good Day,
    I received your information from San Diego Running Injuries website and wanted to run my recent foot experience past you. I noticed trauma to my right foot this Easter, not really realizing how I did anything to my forefoot. The only thing I can remember doing is being on my forefoot a bunch while cleaning the toilets, mopping, cleaning tubs, etc. I noticed my foot swelled for days before I did anything about it. I couldn’t wear my regular shoes because it felt like a big bruise, which is was bruised too. My mom made me go to the urgent care center after looking at my foot. The doctor referred me to a podiatrist. The podiatrist took x-rays and said I had a stress fracture with the 4th metatarsal. I wore a boot for approximately 8 weeks. After those 8 weeks I was still complaining of major pain in my forefoot area. The doctor said I was left with Morton’s Neuroma but not to do anything with it unless I had sharp shooting pains to my toes.

    Next, I went and got a second opinion. This doctor said I didn’t have any signs of having a stress fracture, stating he could see calcified deposits up to a year after an injury. He agreed to Morton’s Neuroma. We completed two cortisone shots within a month. During those treatments, he also had me wear a metatarsal pad while the shot was working. After the second shot the doctor and I decided a third shot probably wouldn’t work since the second one didn’t. I requested an MRI which confirmed Morton’s Neuroma between the 2nd and 3rd metatarsal. The doctor said it was pretty large and said surgery was our option. Now, I’m scared. During the treatment time from April through September, I only wore Croc sandals since I couldn’t wear anything else and babied my foot tremendously. Now, I have to make a decision. I asked about the freezing treatment, but the doctor doesn’t believe in it.

    Can the Morton’s Neuroma eventually heal? Should I get surgery? Will I ever be able to run and walk on my tip toes after surgery?

    I recently bought some new expensive shoes since the shoe salesman assured me they worked well for my type of foot pain. They are Dansko’s professionals. I couldn’t wear sandals since cold weather is approaching and I didn’t want to purchase shoes by internet without trying them on.

    I am stressing hard core!! Today I came on wellness leave to do 20 minutes of cardio to a new dvd I purchased. It’s a basic dvd with no advanced activity. Tonight is miserable!! It hurts to walk…it also hurts just sitting still. The inflammation seems noticeable on the top of my foot. When I walk upstairs, I feel the lump in the ball of my foot. Are you sure surgery is the answer? Everyone who has posted something on Morton’s surgery seems to be negative.

    I appreciate your time in reading my email and appreciate any advise or recommendations you could offer.

    In fact, I would like to meet with you to discuss my options.

    Lisha Russell

  3. Drew says:

    do not get morton’s neuroma surgery– i had it in nov. and my life has been a nightmare ever since.

  4. Edward says:

    Make sure to exhaust all the non-surgical options before turning to the knife. Do your research first! One article that helped me out a lot was: http://why-do-my-feet-hurt.com/morton.html I didn’t even try the surgery, because custom orthotics with a metatarsal pad and a cortisone shot were all I needed. A year later: No Pain!

    See a foot specialist like Dr Rocco. He seems to know what he’s doing, though I don’t know much about him.

  5. Lee says:

    I have Morton’s Neuroma in both feet. I had so much pain in my left foot that I had agonizing (cortizone?) injections and then later had alcohol injections that were also pretty painful. None of it helped. I was wearing orthotics and starting to limp it was so painful and couldn’t think about anything else. I was considering surgery but read that a lot of people have problems afterwards. Then I stumbled on a cure myself. I started going to a gym and getting on a Life Fitness Elliptical 30 minutes a day. I was doing it for the exercise, but about 3 weeks later, I noticed I hadn’t thought about my feet for awhile. When I did start focusing, I realized the pain was completely gone. I can still feel the neuromas–they haven’t disappeared, but there is no pain. Apparently, something about the rolling motion of the elliptical machine must loosen the trapped tissues between the bones or something. I’m not sure if every elliptical will work since they seem somewhat different, but the Life Fitness machine works great for me–plus I lost a bunch of weight!

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