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Posts for tag: Morton's neuroma

We hope your Cooper River Bridge Run training is going well. We would like to talk briefly about a common running injury that we see in our practice which is the Morton's Neuroma. I have personally battled this condition on and off for many years. A neuroma is an inflammation of the digital nerve that runs between the third and fourth digits. Pain typically is sharp or throbbing and feels as if you have something bunched up in your sock. Radiating numbness and tingling can occur between the third and fourth digits. Contributing factors can be reduction of fat pad on the ball of the foot, increased load to the plantar forefoot, higher heel shoes, and tighter toe box shoes. Conservative treatment options would be wider toe box running shoes, oral NSAIDS, offloading metatarsal pads, cross training to decrease load on the plantar foot, cortisone injection, alcohol sclerosing agent injection, and custom foot orthotics.

I would like to give you my personal insight considering that I have struggled with this foot condtion for the past 10 years. My neuroma pain has been managed with conservative treatment. I have custom foot orthotics with offloading metatarsal pad that takes pressure off the inflammed nerve, I have had two previous cortisone injections that have alleviated my pain. Recently I have changed running shoes. I have researched running shoes options and found that the Brooks ghost 11 has been the best running shoe for my neuroma. I feel that Brooks Ghost and Hoka running shoes would be good options if you are suffering from painful neuromas.

As I increase my mileage I do sometimes feel the neuroma so I usually back off my mileage a bit and cross train. I suggest swimming, strength training, and cycyling. Other suggestions would be to run every other day to let the foot rest. Recently I have been running on the beach and I have found that the softer sand decreases ground reactive forces on my forefoot where the Neuroma is located.

I have had patient's not respond to cortisone injections and other conservative options.  If needed  the alcohol sclerosing agent injection is another good option. This type of injection decreases the pain signal of the nerve that is inflammed.

Good luck with your training and if you have any questions please email our practice or respond to the blog.

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Morton's neuroma is a common diagnosis that we see in our practice. A neuroma in the foot presents most commonly with pain in between the third and fourth toes with pain in the ball of the foot. Pain is usually burning, tingling, and shooting pain that radiates into the third and fourth toes and sometimes into the 2nd and 3rd toes. A neuroma usually feels like a sock rolled up in the shoe and feels better upon taking off the shoe and sock. We most commonly see neuromas in women that wear high heel shoes which places much force on the ball of the foot which can irritate the nerve. Neuromas develop over time as well when the fat padding on the ball of the foot reduces as we age.

Dr. Brown and Dr. Saffer practice philosophy has changed over the years regarding the treatment of neuromas. At the most recent American College of Foot and Ankle Surgeons lecturers this year support more conservative treatment for neuromas versus surgical excision as in years past. The one dreaded complication of neuroma surgery is a "stump neuroma" which is a regrowth of the nerve which can cause painful symptoms.

Dr. Brown and Dr. Saffer have had much success with conservative treatment with eventual resolution of neuroma symptoms. Conservative tx options that our practice follows are: NSAIDS, ice, offloading with pads and Orthotics, cortisone injections (max three per year), and the more state of the art treatment alcohol sclerosing agent injections. These type of injections deaden the nerve and reduced symptoms and up to six to seven injections if needed per year can be given. This type of treatment has really helped our patient population that has either suffered through complications of previous surgery or who have not had relief with other conventional treatments. Cryotherapy which is freezing of the nerve is another option as well. Surgical excision is typically the last option for our patients.

Dr. Saffer has suffered from a neuroma several years ago and had relief and resolution with conservative treatment. It is also very important to know if you have pain on the ball of the foot it is not always a neuroma. It could be bursitis, capsulitis, stress fracture, or arthritis. Please refer to our website for more information on neuromas.