Conservative treatment starts with using arch supports or foot pads for your shoes. These help relieve the pressure on the affected nerve. They can be over-the-counter OTC inserts or custom made by prescription to fit your foot. Your doctor may also suggest OTC pain killers or nonsteroidal anti-inflammatory drugs, such as ibuprofen Advil, Motrin or aspirin. If your pain persists, your doctor may try injections of corticosteroids or anti-inflammatory drugs into the area of pain.
A local anesthetic injection may also be used to numb the affected nerve. That may help relieve your pain temporarily. Alcohol sclerosing injections are another remedy that may provide short-term pain relief.
A long-term study found that only 29 percent of people who had alcohol injections remained symptom-free, however. When other treatments have failed to provide relief, your doctor may suggest surgery. Surgical options may include:. For some people, a change to wider shoes or shoe inserts gives quick relief. Others may require injections and painkillers to get relief over time. Surgical recovery time varies. The recovery from nerve decompression surgery is quick.
You will be able to bear weight on the foot and use a padded shoe right after surgery. Recovery is longer for a neurectomy, ranging from 1 to 6 weeks, depending on where the surgical cut is made.
If the incision is at the bottom of your foot, you may need to be on crutches for three weeks and have a longer recovery time. If the incision is on the top of the foot, you can put weight on your foot right away while wearing a special boot. Your doctor will change the surgical dressing in 10 to 14 days. How soon afterward you can go back to work will depend on how much your job requires you to be on your feet. There are few long-term studies of surgical treatment results, but the Cleveland Clinic reports that surgery effectively relieves or reduces symptoms in 75 to 85 percent of cases.
Statistics comparing the results of different treatments are limited. Podometry foot pressure measurement is also helpful to measure the pressure distribution under the bottom of the foot. The physician then uses the results to determine the suitable surgical technique together with the patient. Once approved by the anaesthetist and the surgeon, the surgery can typically be performed the day after the examination.
Surgery is reasonable if conservative treatments such as foot orthotics, shoe supply such as butterfly insoles, foot exercises and self-massage or injecting local anaesthetics cannot provide long-term pain relief.
There generally are two methods which can be used: neurolysis to save the nerve, or removing the nerve. Both procedures take about 30 minutes. Nerve compression is caused by mechanical pressure on the plantar nerve of the foot. The irritation of the nerve causes the connective tissue surrounding the foot nerve to swell, scar tissue develops and fluid build.
The swelling causes ischaemia restriction in supply. The pinching prevents the nerve from being adequately supplied with nutrients. This causes the typical symptoms such as numbness, shooting pain and tingling. These signs of inflammation are reversible to a certain extent if the mechanical pressure on the nerve is eliminated.
For many nerve compression syndromes e. If the Morton's neuroma is not yet too severe less than 0. We have been seeing excellent medical results for years by relieving the nerve and possibly decompression by repositioning the metatarsal bones. We have particularly seen good results with respect to preventing recurrence relapse. Recurrences are considerably more likely after amputating the nerve neurectomy , as this does not remedy the underlying deformity of the arch.
All to often the nerve is simply removed neurectomy to treat Morton neuralgia without evaluating the procedure to save the nerve. Endoscopic surgery to save the nerve for Morton's neuroma, accessing from above instead of from below, holds benefits:.
Neurectomy removes the diseased nerve tissue of the plantar nerve. We also still perform this procedure if the Morton's neuroma swelling is too severe. The MRI sectional images, however, do not always definitively provide information on the size and location of the neuroma. The actual surgical strategy is therefore often only determined during the procedure after directly analysing and viewing the Morton's neuroma. We open the band of connective tissue over the metatarsal head to permanently eliminate pressure on the nerve.
This is called decompression. A neurectomy removing the nerve is a sound treatment method only if the pressure on the metatarsus is also treated. Otherwise, there is a risk of recurrence, so a renewed irritation of the nerve stump with painful swelling of the connective tissue.
Neurectomy is also preferably performed from the top of the foot to avoid scarring in the sole of the foot. This speeds up the healing process and the patient is able to use the foot sooner.
Here at Gelenk-Klinik, a close relationship between the physician and their patient is important. This means: You will be in the care of your treating physician from the initial examination until after surgery. So, you will always have one contact person who will be very familiar with your case and assigned to you throughout your stay at Gelenk-Klinik. Our experts in foot and ankle surgery are the experienced specialists Dr. Thomas Schneider and Dr.
Martin Rinio. The orthopaedic Gelenk-Klinik is therefore a speciality centre with the title "Centre for foot and ankle surgery" ZFS. However, we also offer spinal anaesthesia to avoid general anaesthesia if the patient so desires. In the case of spinal anaesthesia, an anaesthetist injects the anaesthetic into the spinal canal of the lumbar spine. The patient is fully conscious during surgery. You will decide which type of anaesthesia is best for you together with the anaesthetist.
The anaesthetists at Gelenk-Klinik are very experienced in both methods and will choose the option best for the patient and their circumstances based during a pre-operation discussion. The inpatient stay after surgery for Morton's neuroma is typically 2 days. Conservative, non-invasive therapies remain the first-line approach to treating Morton's neuroma. Treatments vary according to the severity of the condition and may include:.
When all else fails, Morton's neuroma can be treated with surgery. Surgery may be considered if conservative therapies fail to provide relief and there is evidence of subluxation the partial dislocation of the metatarsal joints on X-ray, ultrasound, or computed tomography CT.
Morton's neurectomy is the most common approach, which most commonly involves removing the nerve segment. The procedure is generally straightforward.
Surgeons generally approach the area from the top of the foot, identify the nerve and follow it towards the toes and as it courses through the metatarsal bones. It is important that the surgeon cut the nerve far enough back to avoid the nerve from becoming entrapped or scarred on the ball of the foot.
The results of Morton's neurectomy are generally good. Some surgeons approach neuromas from the bottom of the foot for direct visualization, but this leaves a scar on the bottom of the foot—which can become painful to walk on. Another approach that some surgeons utilize is to release a ligament adjacent to the nerve to decompress the area. Here the nerve is left intact. The procedure is performed with small specialized instruments. The main benefit of surgical decompression is that is less invasive than Morton's neurectomy.
A small study conducted in Japan in found it to be highly effective in reducing pain with a minimal risk of complications. Surgical decompression may be appropriate for people with persistent pain but no signs of metatarsal subluxation. Like any medical issue, some treatments work for some patients and fail in others. Bunions and hammertoes are known to transfer weight onto the ball of the foot and inflame nerves, causing a resultant Morton's neuroma. The best cure for Morton's neuroma is to be sure that you have a proper diagnosis, and that other conditions are not causing the neuroma.
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