Treatments for morton’s neuroma
Treatment for Morton’s neuroma is initially medical; If this fails and the patient remains disabled in everyday life, then surgery is considered.
Medical treatment for Morton’s neuroma
First of all, it is necessary to correct faulty weight-bearing that may be causing excess stress in incipient Morton’s disease. The trigger zone is relieved by orthopedic insoles that shift the ground-contact points and reduce pressure under the nodule (sublesional voiding) by shifting contact back from the painful area (retrocapital weight-bearing). These insoles need to be worn inside comfortable shoes.
At the same time, regular injections of local late-action corticosteroids are made.
In the Clinique du Parc, our medical protocol combines a pair of insoles and a series of 3 injections at monthly intervals. The patient is seen again 3 months after the last injection (i.e., 6 months after diagnosis) to assess benefit. If this medical treatment has failed and the patient still feels disabled in everyday life, we turn to surgery.
Surgical treatment for Morton’s neuroma
Surgery can be either conservative or non-conservative.
Conservative treatment aims to free the canal in which the nerve is enclosed, without operating on the nerve itself.
The ligament is sectioned or resected between the metatarsal heads, as a necklace around the “neck” of the Morton nodule. This can be done by classical surgery, minimally invasive surgery (to which osteotomy of the 4th metatarsal head may be associated) or endoscopic surgery.
by E. Rabat
Non-conservative techniques consist in simply resecting the Morton nodule.
This involves cutting the 4 nerve branches around the nodule and completely removing it; it is then analyzed microscopically.
This obviously gets rid of pain, as the whole nodule is removed. However, there can be certain side-effects or complications such as cicatricial neuroma (partial and very painful nerve regrowth), more or less total desensitization between the 3rd and 4th toes, or skin scar disorder and fibrosis induced by surgery.
It is classically admitted that postoperative problems can take a long time to resolve, and are fairly unpredictable from one patient to another.
However, it should be borne in mind that Morton’s neuroma can be successfully treated medically in 80% of cases, with good results. Surgery is reserved just for the most serious and disabling forms that impair everyday activity. The choice of surgery has to be made with the surgeon. Even so, Morton’s neuroma is never entirely cured, whatever the treatment, and the aim is to minimize pain.
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The information for this article was drawn from:
Barrett SL. Endoscopic nerve decompression.Clin Podiatr Med Surg 2006 July; 23 (3): 579-95. Review.
Dellon AL. Treatment of Morton’s neuroma as a nerve compression. The role for neurolysis. J Am Podiatr Med Assoc 1992 Aug; 82 (8): 399-402.
Mulder JD. The causative mechanism in Morton’s metatarsalgia. J Bone Joint Surg (Br) 1951; 33: 94-5.
Villas C, Florez B, Alfonso M. Neurectomy versus neurolysis for Morton’s neuroma. Foot ankle Int 2008 June; 29 (6): 578-80.