Neuromas

Pain, numbness or tingling in the forefoot, usually between and extending into the third and fourth toes, almost always indicates a neuroma. A neuroma often hurts more when you’re wearing shoes and feels better when you take them off and massage the feet. Neuromas slowly become more painful with time if left untreated.

Causes:

A neuroma is caused by pinching or irritation of one or more nerves in the forefoot. This isNeuroma usually the result of poor biomechanics and/or over-pronation. If you over-pronate, the metatarsal bones can have excessive movement which in turn can cause irritation, by a tight ligament, to the nerve which runs between the metatarsal heads. The result of this direct irritation is inflammation and pain. If a neuroma is left untreated the nerve can become chronically scarred, creating even more pain.

Treatment:

You can try using a metatarsal pad under the affected area. This should reduce some of the excessive motion of the metatarsals and hopefully reduce the pain. Exact placement of the pad is important. Custom orthotics are often used to control the over-pronation. They often incorporate a specialized metatarsal pad within them and can occasionally provide more relief. If this doesn’t work a podiatrist should be consulted to assess the degree of nerve damage. An injection may be warranted. An excellent new option is a minimally invasive nerve decompression (MIND) procedure. This is a simple in-office procedure, which provides very effective, long-term relief of the chronic pain from neuromas. As a last resort, open surgery might be indicated to remove the damaged nerve. This will solve the problem, but will lead to permanent numbness between two toes.

Prevention:

Since over-pronation is very often the culprit, switching to running shoes with more motion control should be helpful.

Activity Restrictions:

None really, but it is best to wait until the pain subsides or is treated before engaging in long runs or lengthy activities.

New Neuroma Treatment:

New Neuroma TreatmentOpen surgical treatment has been used for decades and can have it’s drawbacks including permanent numbness in the affected two toes, regrowth of the nerve and time off one’s feet for recovery.

NeuromaThe anatomy exhibits that a ligament called the intermetatarsal ligament holds the adjacent metatarsal heads together. These ligaments tend to bring the metatarsals closer together, not allowing them to spread apart. Much like carpal tunnel syndrome in the hand, the nerves become entrapped under the ligament and become irritated. It is believed that if the adjacent metatarsal heads could move apart slightly, it would allow for less squeezing of the nerve. Releasing or cutting the affected intermetatarsal ligament allows for more space and less restriction of the nerve, especially in the third/fourth intermetatarsal space where nerve entrapment is most common.

Koby Surgical (www.kobysurgical.com) has developed precision instrumentation to allow doctors to effectively release the intermetatarsal ligament. Modelling their instrumentation and theories after carpal tunnel procedures, this new technique is a breakthrough in treating Morton’s Neuroma. Koby has recognized the doctors at Allied Foot Specialists as one of the first doctors in Canada to use this particular procedure.

Allied Foot Specialists continue to be leaders in Canadian podiatric treatments and is committed to utilizing the most innovative, modern procedures and instrumentation.

The Minimally Invasive Neuroma Decompression (MIND) procedure is performed in the office under local anaesthetic. It involves placing the precision instrumentation in the affected area and releasing the intermetatarsal ligament. The procedure takes under ten minutes and patients walk immediately after. There is minimal “down time” required and patients can resume normal activities very quickly. There is minimal, if any, post operative pain and patients can walk immediately.
“The Isogard system by Koby is the technique of the decade because it is so innovative and minimally invasive”. The Isogard system is remarkably simple and allows for patients to resume activities in days rather than weeks. The MIND procedure has a small (3 – 5%) failure rate, if this occurs the patient may opt for traditional neuroma excision.