As a foot specialist, Morton’s Neuroma is one of the top 5 conditions that I see and treat at my clinic. I feel frustrated in clinicians who take this condition very benignly without a complete understanding of why it happens, how to confirm diagnosis and how I treat it.
Patients often expect their feet to hurt and just see it as a byproduct of bad footwear.
During my training, I was regularly told that you can diagnose it by just feeling, examination and what the patient tells you. Then you read the patient reviews online and hear of the horror stories of failed surgery and continued pain. Was it enough to just diagnose clinically, or did we miss something.
This is where I have developed a philosophy to do things differently. Both I, and the patient need to see it to believe it! I work closely with experienced musculoskeletal radiologists, meaning that they specialise in bones and joints. Not only that, I work with those that specialise in feet. We don’t cut corners during the diagnostic stages. No treatment is carried out until a firm diagnosis of neuroma, bursa or both is obtained.
For most cases an ultrasound is enough. It shows the neuroma
. You can find out how big it is and if there are more than one. If I’m not certain and I suspect more than one problem exists, then I would request an MRI alongside a contrast agent that highlights the neuroma and helps exclude other causes of pain in the ball of the feet, such as joints, tendons or ligament problems.
We then proceed to treatment of your Morton’s Neuroma. No matter what the size is, we always advise on injections before surgery. Often simple changes such as wider shoes or specialist insoles can help. Should we perform injection of steroid then it is almost always under ultrasound guidance to allow most accurate placement of the injected medicine.
It is also true that 50% of painful Morton’s neuroma patient need to have surgery eventually. I certainly do not believe in too many injections. I have see thinning of skin and reduced cushioning from fat when too many injections have been given to the same area. If 2 injections have not worked then surgery is a reasonable alternative.
The neuroma operation can be performed under local anaesthetic or with sedation if required. Typical recovery is 4 weeks. However you can return to a desk job 1 week after the operation. Swelling does take a while to settle down.
by Kaser Nazir – Consultant Podiatric Surgeon