The Center for Podiatric Care and Sports Medicine

Are You Afraid of Morton’s Neuroma Surgery? Then Neurolysis Might Be For You

Posted by on Wednesday, October 24th, 2012

When we talk about nerves, we can talk about them in a variety of ways.

“The nerve of her to show up at the wedding after what happened with Brian!”

That means nerves so tough that the nervy one doesn’t care who she hurts or what people think. Same for “He must have some nerve to ask me for a reference after what he said at the office holiday party!” See? Tough nerves, nerves of steel.

“That sound is getting on my nerves!”

As much as we may use the “cold as ice,” “hard as a rock” version of “nerve” to describe people, this “getting on my nerves” picture is more accurate–after all, nerves are sensitive. They feel, they get agitated, they tell our brains about the good and bad things affecting our bodies.

A Morton’s neuroma is one of those bad things.

What? A bad thing? And it’s such a lovely name. I know, but sadly they are very unpleasant things. Just a quick refresher: a neuroma is a piece of nerve tissue that has thickened. You can have a neuroma anywhere in your body–for example, an acoustic neuroma is found in your ear. One of the most common types is a Morton’s neuroma, or intermetatarsal neuroma, which is found between your third and fourth toe. The symptoms include: feeling like you have a bump or knot  in the ball of your foot; tingling and numbness in the ball of your foot; pain in the ball of your foot.

Well, what do you do about these things? Ah ha–that’s our topic for the day. A podiatrist at The Center for Podiatric Care and Sports Medicine (212.996.1900) will start with a conservative approach. You’ll be told to avoid shoes that pinch or squash your toes, to ice the painful area, to stay away from activities that agitate the nerve until the pain goes away, to take an anti-inflammatory like ibuprofen, and to wear padding or custom orthotics that can take the pressure off the ball of your foot.

If that doesn’t work, your podiatrist may give you a cortisone shot to relieve the pain and inflammation. The most extreme step is a surgical procedure to remove the nerve.

If you don’t want to have surgery, though, there is another option: chemical neurolysis.

What is neurolysis? It sounds like a word used to describe an insecure, needy person. Not even close–chemical neurolysis is a procedure that can be used to destroy the painful neuroma.

Treatment of a neuroma with chemical neurolysis means that you will get a series of injections of ethanol mixed with anesthesia. The ethanol destroys the neuroma little by little until it is gone. This usually takes about five to seven injections, with a gap of about ten days in between. The success rate of pain relief from neuromas through chemical neurolysis is very good, about 61%-89%.

If you take seven treatments with ten days in-between, you’re looking at a period of about two and a half to three months before the pain is gone, which may not seem that much different from the time it would take to recover from surgery. However, there are a lot of differences in how easy that time period would be for you. Surgery means cutting open your foot, which means the exposure of nerves that cause pain and the risk of infection. You’ll need stitches and probably painkillers for a few days. You won’t be able to put any weight on your foot for a considerable period of time while the wound heals.

With neurolysis, on the other hand, you may feel some pain the day after an injection, but you definitely will be able to put weight on your foot and do most of your normal activities; there will be much less disruption in your life than you would have from surgery. You can practically do all your treatments on your lunch hour. Additionally, there’s no risk of infection and no stitches to deal with. Really, the traditional surgery is about as much fun as doing your taxes, but neurolysis is like, well, having someone offer to do your taxes for you!

If you have a Morton’s neuroma, then your podiatrist can talk to you about the best options for your treatment and whether neurolysis is right for you. The important thing is to do something–your sensitive little nerve is trying to tell you that it needs help. The nerve of it!

 

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, and Dr. Ryan Minara have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.