Foot neuroma surgery
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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In many instances, initial treatment consists of padding and taping to take the weight off the neuroma.
If the patient has pes planus (flat feet), an arch support is used. The patient should wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be given.Sometimes a sclerosing solution such as alcohol is injected to "kill" the neuroma. The pain can also be relieved a bit by wearing a custom-fitted orthotic.
If conservative treatment does not work, two surgical procedures are available.
The dorsal approach involves an incision on the top of the foot. This approach allows the patient to walk soon after surgery because the stitches are not on the weight-bearing side of the foot.
An incision is made on the top of the foot in the location of the neuroma. This is most commonly in the area between the second and third toes or between the third and fourth toes.
The second procedure involves a plantar approach, in which the incision is made on the sole of the foot. The advantage of the plantar approach is that the neuroma can be reached easily and resected without cutting any structures.
If the skin incision is made on the bottom of the foot the patient may be required to use crutches for up to three weeks. Additionally, it takes longer for the skin on the bottom of the foot to heal.
The time required to be off from work will depend upon the type of work being and the type of shoe that must be worn. If the patient can work with their foot propped up and elevated with a limited amount of walking, they may be able to return to work within a week of surgery. Patients who have jobs that require prolonged standing, walking, kneeling or climbing may be off from work for a longer period.
Complications can occur. Once the neuroma is removed, a hematoma (collection of blood) can form. There is a risk for infection.
Recurrence is another possibility. If this occurs, the nerve grows in width and length, creating a burning pain that can be treated by injection or further surgery.
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