Wednesday, September 26, 2012

Effective Neuroma Treatments Without Surgery

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.

FFLC has both the high energy and low energy modality for your care. Discuss with your doctor which is right for you.

Fridman R, Cain JD, Weil L. Extracorporeal Shockwave Therapy for Interdigital Neuroma. A Randomized, Placebo-Controlled, Double-Blind Trial. JAPMA. Vol 99, No 3, May/June 2009

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