Mortons Neuroma

scoot67

Hi all I have recently been diagnosed with Mortens Neuroma and wondered if anyone else has the same problem
Is it cycling related ?? I'm very much a leisure cyclist and only do around 25-30 miles a week for the last 6 months
The surgeon i saw suggested that surgery is the only answer but after a quick "google" it appears that this isn't always 100% relaiable

Any advice on managing this condition would be greatly received

Novomix30

I hope this helps.

There are options in conservative treatment (non-surgical), but this is the latest supplied evidence I can locate.

I am a medic as well, but not a surgeon.

Conservative treatment should precede expensive diagnostic procedures. This approach involves decreasing pressure on the metatarsal heads by using a metatarsal support or bar or padded shoe insert. Several studies have measured the loading pressures placed on metatarsals before and after use of metatarsal pads, bars, orthotics, and specialized orthopedic shoes [31-36]. In all reports, pain relief correlated with reduction in pressure. Proper placement of the inserts just proximal to the metatarsal head is important. No randomized controlled studies have been performed.

Treatment inserts should be placed in both shoes, even when symptoms are unilateral, to ensure that the patient walks evenly. Symptomatic relief often begins within a few days of insert use and pain may completely subside over several weeks.

A broad-toed shoe that allows spreading of the metatarsal heads may be helpful. Proper shoe width should be determined while standing, using a professional shoe fitting device. If width has changed, older shoes should be discarded.

If conservative measures fail to relieve symptoms, a single injection of a local anesthetic and glucocorticoid into the site of tenderness can be performed using a dorsal, not plantar, approach [37,38]. A plantar approach is more likely to cause complications. A combination of methylprednisolone (20 mg, or 0.5 mL) and one percent lidocaine (0.5 mL) may be used.

Ultrasound guided injection is preferred by many practitioners although studies are limited. Ultrasound can distinguish neuroma from adjacent joint synovitis or bursitis. The majority of patients experience some relief with ultrasound-guided injection according to three case series involving a total of 113 patients [39-41]. Complications are rare; metatarsal fat pad atrophy can be debilitating but may occur less often if a dorsal injection is used. No randomized controlled trials have been published.

Surgical removal of the neuroma and nerve may be necessary in patients who remain symptomatic after 9 to 12 months of nonoperative therapy. Surgical success rates of up to 80 to 90 percent are reported in uncontrolled studies [37,42-44]. Surgery performed using a dorsal approach resulted in more timely weight bearing, return to work, and less painful scarring [45]. No randomized trials of surgery for plantar neuroma have been reported. Rarely, a neuroma may recur following surgery. Experience using injections of alcohol, phenol, and other substances and with nerve transplants is limited.

suze

Friend of mine had similar issues with his foot. You can read his experiences on the team wiggle blog.


http://www.teamwiggletandem.com/blog_16.html

yakk

Hi there, Novomix30's very detailed reply is very helpful. I work closely with podiatrists, and we come across this frequently. As stated above, footwear fit is paramount.
Also related and sometimes the cause of the neuroma is thicking of the metatarso-phalangeal joints (the 'knuckles' of the foot) due to joint capsulitis (as mentioned above), which decrease the space between the metatarsal heads, thus irritating nerves.

(Another diagnosis as an outside is Tarsal Tunnel syndrome, where you get nerve impingement/interference from the inside of the ankle - that can refer pain and pins & needles/numbness to the foot/toes).

We conservatively manage patients - orthotics (inner soles) with metatarsal pads and correction of alignment if necessary/helpful, as well as stretches for tight muscles (usually calves, as tightness here can cause feet to roll in more, increasing stress of the 'knuckle' joints), strengthening of weaker muscles etc, and relative rest!

Cushioned footwear cAn also be useful as this can relieve pressure on the sometimes painful 'knuckle' joints.

Main point to take away and to agree wholeheartedly with Novomix30, go down the conservative (ie non-surgical) route first, and probably the first port of call should be a podiatrist in my opinion.

best of luck with it and wish you a speedy recovery.
Yak

scoot67

Sorry for late reply not been on pc much

Thank you for taking the time to write such a detailed answer I will look into this

My GP wasn't as helpful when I went back to see him

I tend to wear trainers most of the time which although aren't all that cushoined are not tight fitting(althogh I do have wide feet)I have wondered if Doctor Marten footwear would be beneficial ??

yakk

Hi there, Dr Martens aren't too bad. It really depends on what you find more comfortable, really. Just to reiterate the advice given above. Pity about your GP - is there another one you can see in the surgery for a second opinion?
Good luck with it.
Yak