By Dr. Lou Pack
“I have a neuroma and was told I need surgery. Is there any alternative?”
Neuromas are one of the most common, yet most misdiagnosed, of all foot conditions. A true neuroma (Morton’s Neuroma) is an enlarged nerve that almost always occurs between the third and fourth toes. And despite the diagnosis of this condition in other locations, this is rarely, if ever, the case.
Typically, there is electric shock like pain into those toes that increases with walking and tight shoes. Symptoms often decrease with shoe removal. Numbness, tingling and burning may also occur and is usually accompanied by swelling.
Anything that causes friction or irritation in that area can cause a neuroma. But those same factors can also cause symptoms that mimic a neuroma. It is therefore extremely important to determine whether a true nerve enlargement exists, or if the symptoms are indeed secondary to another condition.
For example, people who have arthritis often get inflammation of the joints (third and fourth metatarsal phalangeal joints) which are in close proximity to the nerve. With swelling, pressure is placed on the interdigital nerve and symptoms of a neuroma can occur. Obviously, if the symptoms are due to another cause (like arthritis), surgical resection of the nerve would not only be incorrect, but could lead to many other complications. You should also know that if removed, a neuroma can recur.
Although frequently utilized and sometimes helpful, cortisone injections do nothing to treat the actual pathology of the lesion or the cause. Indeed, for continued relief, it is very important to find and treat the true causes of the enlarged nerve and not simply the neuroma itself.
In almost all instances, biomechanical or structural problems, such as tight calf muscles or pronation (a flattening of the feet) cause neuromas. In such instances stretching and precisely made, fully custom inserts, that repositions the foot and eliminates the sheering forces that caused pressure on the nerve, are very helpful. Often, local (painless) injections of vitamin B12 are quite effective in eliminating painful symptoms.
It is important to remember that the same biomechanical and structural problems that cause neuromas are often responsible for arthritic symptoms in the knees, hips and low back. By conservatively treating the underlying causes of the neuroma, instead of injecting them with cortisone, surgery is most always avoidable and often, other joint pain may be resolved as well.
A former reconstructive foot and ankle surgeon and past clinical instructor of Medicine at Emory, Dr. Pack practices at MCG in Greensboro. He works with patients who have arthritis and wish to decrease joint symptoms and remain active without medication or surgery. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCAA national champions). For further information please see www.drloupack.com, drloupack.blogspot.com or contact him directly at (706) 454-0040.
