A Morton’s neuroma is an inflamed nerve in the ball of the foot. The inflamed nerve causes pain which shoots out to the 3rd and 4th toes. Tingling, burning or numbness may accompany the pain and some feel as if they are walking on a lump, a bunched up sock or a lamp cord. The pain is generally worse with standing or walking and there may be a “twang” sensation in the ball of the foot.
Conservative therapies for neuromas include neuroma pads, rigid-rocker type shoes with a wide toebox, anti-inflammatory medications, icing, contrasting between hot and cold, steroid injections and nerve sclerosing injections. When conservative therapy fails, the neuroma is excised. The success rate for neuroma surgery has been reported at 85%. Complications specifically associated with neuroma surgery include stump neuroma, neuritis and continued pain. All patients will experience numbness in the bottom of the 3rd and 4th toes after the surgery.
A new study published in the Journal of the American Podiatric Medical Association found extracorporeal shockwave therapy to an effective treatment for Morton’s neuroma. The researchers recruited twenty five patients with a Morton’s neuroma which was unresponsive to at least eight months of conservative therapy. The patients were randomly divided into two groups, an active treatment group and a sham treatment group. Both groups were given intravenous sedation and a local injection. The active treatment group received extracorporeal shockwave therapy with an OssaTron device while the sham group did not receive any treatment. After 12 weeks of follow-up, 69% of the active group had a significant improvement in symptoms, compared with 40% of the sham group. Eight percent of the treatment group had no improvement of symptoms, while 30% of the sham group had no improvement of symptoms.
Extracorporeal Shockwave therapy is the delivery of high-energy sounds waves to an affected area of the body. The high energy sound waves caused microscopic damage to the area and this triggers a healing response by the body, initiating new blood vessel formation and delivery of healing factors to the injured site. Potential complications associated with extracorporeal shockwave therapy include bruising of the skin, swelling, pain, numbness, tingling and hemorrhage, but the incidence is less than 1%. Four of the patients in this study in the active treatment group went on to surgical excision of the neuroma. The pathology report revealed “traumatic neuroma” in 50% of those cases. Further research is needed to evaluate the amount and extent of nerve damage that may be caused by extracorporeal shockwave therapy.
The limitations of this study are the small patient population and the quantification of pain and symptoms. Although the results of this study show the potential for extracorporeal shockwave therapy to be a safe and effective alternative to surgery for Morton’s neuroma, some critics of the study question the validity of the author’s conclusions. More on neuromas.
Fridman R, Cain JD, Weil L. Extracorporeal Shockwave Therapy for Interdigital Neuroma. A Randomized, Placebo-Controlled, Double-Blind Trial. JAPMA Vol 99, No 3, May/June 2009.
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