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

READER MAY NEED SECOND SURGERY FOR PAIN OF MORTON'S NEUROMA

Question: I've had surgery for foot pain caused by a Morton's neuroma. About six months later I had a return of the pain. This was caused by a reaction to the sutures used in the first surgery. Now I have pain again, and my MRI shows that I have two more neuromas. Why do these keep coming back, and is there anything I can do to prevent more trouble?

Answer: Morton's neuroma is a relatively common cause of pain in the foot. It is actually a non-cancerous tumor of the nerve that runs between the toes. This tumor can start as a consequence of a single injury, but more commonly 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 the discomfort each of us has experienced when walking barefoot and accidentally stepping 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 the yard barefoot! Individuals with Morton's neuroma have this experience without stepping on a stone. In the worst cases, just standing is enough to trigger this unpleasant sensation.

Morton's neuroma can be treated in several different ways. Non-surgical treatment including foot manipulation and various physical therapy modalities, and foot orthotics give relief in about 40 percent of those with relatively mild symptoms. More severe symptoms, as you apparently had and may now have again, require surgical treatment.

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." 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. Virtually every patient agrees that the resulting toe numbness is an acceptable "trade" for the previous 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. In one study, more than 90 percent of individuals who had surgery for Morton's neuroma at least four years before reported continued relief of symptoms. Other studies showed a success rate of over 95 percent.

Of particular relevance in your case, research shows that 80 percent of that small group that failed to have a satisfactory result from a first surgery did experience relief with a second procedure. Furthermore, the reaction you had to the sutures used in your first surgery is an uncommon problem that can generally be avoided in subsequent surgeries by using a different type of suture material.

Because of the high success rate for neuroma surgery, I would urge you to consider having your new neuromas removed. An additional treatment consideration may include using custom made shoe inserts called orthotics to help your feet work optimally and, thereby, minimize stress on areas of the foot where neuromas form. Talk to your podiatrist or orthopedic surgeon about the best treatment for you.

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.