FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SURGERY MAY GIVE KICK TO MORTON'S NEUROMA'S FOOT PAIN

Question: I've been to several doctors because of foot pain. They have all told me that I have a benign tumor called Morton's neuroma. One doctor wants to operate on my foot, but he said that afterwards I would have numbness in the area where I now have pain. My foot only hurts when I've been on it for quite a while, walk barefoot in the house, or if I step on a rock that hits the nerve. Is surgery for this Morton's neuroma advisable?

Answer: Morton's neuroma is a relatively common cause of pain in the foot. It is actually a tumor of the nerve that runs between the toes and, as you have indicated, is non-cancerous. This tumor can start as a consequence of a single injury. More commonly, however, it is the result of repeated minor injuries from improperly fitted shoes or other foot problems such as flat feet.

The foot pain of Morton's neuroma is much like what you experience when you are walking barefoot and step on a stone especially if the stone presses on the joint just behind one of the toes. When this happens to me, it usually produces an ungraceful dance accompanied by a string of colorful expletives. I know better than to be walking around barefoot! Individuals with Morton's neuroma have this experience without stepping on a stone. In the worst cases, just standing is enough to do it.

Not all foot pain is due to Morton's neuroma, however. Fractures of the foot bones often cause a very similar pain. Stress fracturea hairline spiraling breaks without significant separation of the two pieces of bone most closely mimic Morton's neuroma. Prolonged marching or jogging are common causes. Also, bruising of the foot bone, a condition called metatarsalgia, and the thinning of the fat pad on the bottom of the foot can produce symptoms similar to Morton's neuroma. So, I hope that your doctors have done some tests to supplement the finding of their physical examinations of your foot and the history of your pain. X-rays, ultrasound and magnetic resonance imaging may be necessary in some cases to accurately define the cause of foot pain.

Morton's neuroma can be treated in several different ways. Non-surgical treatment including foot manipulation, various physical therapy modalities, and foot orthotics gives relief in about 40 percent of those with relatively mild symptoms. More severe symptoms require surgical treatment, as do milder symptoms like yours, when conservative care fails to bring improvement.

Surgery for Morton's neuroma involves removal of the fibrous nerve growth from between the toes. This is usually done by making an incision on the top of the foot, not on the bottom. The offending growth is then removed or "clipped," as your doctor said. This "clipped" nerve is no longer connected to the toe, so the toe itself will be numb after the surgery. The important issue is that the foot pain is also gone. Essentially every patient agrees that the resulting toe numbness is acceptable as a "trade" to replace the foot pain.

There have been many scientific studies over the past few years that show the high rate of patient satisfaction with surgery for Morton's neuroma. Over 90 percent of individuals who had surgery for Morton's neuroma at least four years previously reported continued relief of symptoms. Some studies showed a success rate of over 95 percent. Of those who failed to get satisfactory relief from the first surgery, 80 percent had relief with a second procedure.

So, if you have sufficient discomfort from your Morton's neuroma to be willing to have surgery and only you can decide this it is quite likely that surgery will be successful in giving you relief.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.