Morton's Neuroma

Q:  Eight years ago I had a Morton's Neuroma removed from my right foot. It was between my second and third toes. I have never been able to wear a pair of "street" shoes comfortably since then. Believe me, I have tried both expensive and inexpensive shoes to no avail. I have been in constant discomfort since the operation. Several months after this operation I returned to the operating surgeon who said he could do nothing more for me.

I looked for another podiatrist who thought that the original surgeon did not get out all the nerve endings. No matter what, I have constant discomfort. Is there a solution to my misery or do I continue on for the rest of my life like this? Can another operation remove the nerve endings (if this is a fact) after this length of time?

A:  Morton's neuroma is not really a "nerve tumor" as you might guess from the term, but an irritation and entrapment of a nerve from the ligament lying above it. The location of the pain is usually between the 2nd and 3rd toes or the 3rd and 4th. Treatment first consists of a decrease in walking and changing from high heels to flat shoes. Pads for the weight-bearing part of the foot may help relieve the pressure on the nerve. About half of people eventually require surgery which usually is quite successful, but unfortunately not in your case.

Richard Marks, MD, Assistant Professor of Orthopedic Surgery at the Medical College of Wisconsin and Director of the Foot and Ankle Division, thought that there were two possibilities to explain why you still have pain. Either the nerve was not entirely removed or the diagnosis of a neuroma was not correct. There are inflammations of the foot joints and bones that can cause similar pain. Dr. Marks says that about 85% of "re-do" operations are successful, but he would suggest trying a soft insert pad in the shoe first. In addition, if you experience relief from an injection of xylocaine, a local anesthestic, into the foot, it would help confirm the diagnosis of neuroma. Bottom line, there can be relief for you, even after eight years!

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.