There are surgical and non surgical treatments for neuromas. Xrays are usually taken to rule out some bony pathology such as fractures, dislocations, tumors, spurs, deformity and arthritis. Xrays are also used to evaluate the foot structure and bones. Most of the time, people with neuromas have metatarsals which are not evenly spaced, creating an environment for the nerve to be “pinched”. To better visualize the actually neuroma an ultrasound or MRI may be ordered.
After initial office exam and diagnosis the doctors at City Podiatry will often start with conservative treatments such as shoe gear adjustments. Making simple foot wear changes can often help such as avoiding high heels and tight or narrow shoes. Wearing wider shoes with lower heels and a softer sole is often recommended at first, as well. Old and worn out shoes should be replaced. Shoe changes allows the bones to spread out and reduce pressure on the nerve, giving it a better chance to heal.
Some at home treatments that are often recommended include doing a light massage and stretch to the area in between the metatarsals, which is where the neuroma is located. This is best done after a warm bath or shower and after application of moisturizer because the soft tissue is warmed up and can be more pliable. Afterwards, placing an ice pack on the affected area helps reduce swelling and inflammation. Icing is also helpful especially at the end of the day.
When suffering from neuroma symptoms some activity modifications may also be recommended. The neuroma symptoms can be any combination of: burning, stabbing, shooting, throbbing and numbing. Activities that put repetitive and high impact pressure on the neuroma should be avoided until the condition improves. Patients will often feel the symptoms after running or long walks. Your doctor may try padding techniques to your shoes in effort to provide support to the ball of the foot and lessens the pressure on the nerve. This can decreases the compression when walking.
If temporary padding is helpful, your doctor at City Podiatry will often then discuss custom molded orthotics or shoe inserts incorporating the prescription padding specific for neuromas. Custom molded orthotics can help relieve nerve irritation by lifting and separating the bones thus alleviating pressure on the nerve. Some popular prescriptions include: metatarsal pads, metatarsal bars, neuroma pads, dispersion pads, and cushioning.
Your doctor at City Podiatry may also recommend injection therapy for treatments of neuroma pain. Cortisone is commonly injected into neuromas and have proven to be effective in reducing the swelling and inflammation associated with the nerve. City Podiatry doctors often use an in office diagnostic ultrasound to accurately place the injected steroid. Larger, chronic and more inflamed neuromas may necessitate multiple injections over a period of time.
Another type of injection therapy is with use of a special type alcohol. Alcohol solutions have proven to be effective as well. Where cortisone reduces the inflammation of the nerve, the injected alcohol solution desensitizes and sclerosis, or attempts to shrink the nerve. Usually these require a series of five to six injections performed biweekly.
If these conservative measures fail and the patient still has considerable pain, surgery can be considered. Most neuroma surgeries today are aimed at being less invasive and less traumatic. Percutaneous, minimal and small incisions through the skin, creates less post operative swelling, allowing patients to return to shoes and activity sooner.
Traditional surgical removal of the neuroma is being performed less and less today due to the success of the more minimal procedures. Surgical removal of a neuroma also has the potential complication of developing scar tissue around the remaining nerve, called a “stump neuroma”. However, in some resistant and chronic cases, neuroma excision still may need to be performed. The procedure is performed through a small incision and once the neuroma is identified it is removed leaving either ends of the nerve intact. The procedure takes about 3-4 weeks to recover due to having stitches, bandage and surgical shoe.
One of the minimally invasive procedures the doctors at City Podiatry perform is where the ligament adjacent to the neuroma is cut thus reducing friction and irritability of the nerve. This also creates a larger space between the metatarsals so the nerve is not pinching as much.
Another very popular procedure is called radiofrequency ablation. This is a minimally invasive procedure with no incision necessary. The procedure works by an electrical current which generates a heated radiofrequency needle that cauterizes the neuroma. This is a same day outpatient procedure that requires just light sedation and local anesthesia. Once the neuroma is identified ,electrical current passes through the needle to heat the nerve tissue for about sixty to ninety seconds. A small and light dressing is applied and can be removed in a few days following the procedure.