Most Neuromas Don't Need Surgery

Anyone who has experienced the shooting pain, and occasional burning, numbness and pins-and-needles sensation, of a neuroma of the foot remembers how he would have eagerly submitted to any kind of surgery to relieve the torture. But nowadays, surgery is only the most extreme intervention after three other remedies have been tried. A so-called Morton's neuroma is an abnormal fibrous growth around a foot nerve, usually in the metatarsal area between the third and fourth toes. The enlarged tissue, with the nerve in the middle, is squeezed between two metatarsal bones, producing the excruciating pain associated with the condition. It's especially agonizing when the foot is squeezed into a shoe.

The first step in treating a neuroma, before even thinking about surgery, is to change one's shoes and/or insoles to give the foot more room. If that fails, the podiatrist examines the foot with an X-ray machine and ultrasound device to ensure the problem is only a neuroma.

If that's the case, the doctor injects cortisone into the affected area. The purpose of the cortisone injections is to fight inflammation and destroy tissue - the target tissue being the abnormal fibrous growth. Usually, the doctor administers a maximum of three cortisone injections, at least two weeks apart. If that approach doesn't work, the podiatrist turns to alcohol injections, which are designed to chemically dissolve the growth.

The procedure is also called sclerosing the nerve. Such injections help more than 75 percent of all patients avoid surgery. The other quarter of the patients must either learn to tolerate their pain or undergo surgery, which takes about a half-hour, with local anesthesia and a little sedation. Patients recover rather quickly, getting their sutures removed and returning to normal activities in about two weeks.

 Generally speaking, neuromas that are less than 5 millimeters wide are cured by cortisone injections; those between 5 millimeters and 10 millimeters are cleared up by sclerosing, and those larger than 10 millimeters must be surgically removed.


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