Morton's neuroma is an inflamed nerve that causes pain,
tingling and numbness in the ball of the foot. Many complain of a bunched up
sock under the ball of the foot, while others complain of walking on a lump, a
large pebble or a lamp cord. Some describe a "twang", like a guitar
string, in the ball of their foot. The pain can dull in the ball of the foot or
can be radiating, electrical, tingling or burning and shoot to the 3rd and 4th
toes. The pain is worsened with tight shoes, standing, walking, hills and
stairs and generally relieved by rest and removal of shoes.
The initial treatment for Morton's neuroma
is to eliminate factors which may have caused or aggravated it. In many cases,
tight shoes cramp the toes and press on the nerve, causing irritation, inflammation
and pain. Over-pronation causes forefoot instability and excess movement of the
long bones in the foot. This type of abnormal foot mechanics, in combination
with soft, flexible shoes can cause a neuroma.
Icing the ball of the foot twice a day for
15 minutes and/or contrasting between hot and cold for 30 minutes each day will
help decrease the inflammation. Anti-inflammatory medications, such as
ibuprofen or naproxen, can also decrease the inflammation and the pain. A
neuroma pad will help disperse forefoot pressure, decreasing irritation on the
nerve. Steroid injections and nerve sclerosing injections may also be used.
When conservative therapy fails, surgery is
recommended. Surgery involves releasing the ligament placing pressure on the
nerve or removing the neuroma. When the neuroma is removed, permanent numbness
at the toes will result, but toe function is not affected.
In a new study published in the Journal of
the American Podiatric Medical Association, researchers found extracorporeal
shockwave therapy to be a safe and effective treatment for Morton's neuroma.
Extracorporeal shockwave therapy (ESWT) is a treatment which directs powerful
sounds waves at an area of injury. The sounds waves create vibrations causing
microtrauma to the tissues.
The body responds by creating new blood
vessels and sending healing factors and inflammatory cells to the area to
stimulate the natural healing process. ESWT has been used for the treatment of
kidney stones for many years. In the year 2000, the FDA approved ESWT for the
treatment of chronic plantar fasciitis, a painful condition in the heel. ESWT
is not currently approved for the treatment of neuromas.
In this study, researchers divided twenty
five patients with a Morton's neuroma, unresponsive to at least eight months of
conservative therapy, to an active treatment group or a sham treatment group.
Both groups were taken into the procedure room and given intravenous sedation
and a local anesthetic. The active treatment group received extracorporeal
shockwave therapy and the sham group received no treatment.
At 12 weeks following the procedure, the
group with the extracorporeal shockwave therapy had significant pain reduction
compared to the sham treatment group. Potential complications associated with
extracorporeal shockwave therapy include bruising, pain, swelling, nerve damage
and hemorrhage, but the incidence is less than 1%. This results of this study
are encouraging and ESWT may prove to be an effective treatment alternative to
surgery. But, this is a small study and further research is needed to evaluate
the safety and efficacy of extracorporeal shockwave therapy for the treatment
of Morton's neuroma.
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www.NaplesPodiatrist.com
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