Hai-En Peng, DPM - Podiatrist, Foot/Ankle Surgeon, Southern California, Thousand Oaks

Neuroma Surgery

In most cases, initial treatment consists of padding and taping to disperse weight away from the neuroma. If the patient has flat feet, an arch support is incorporated. The patient is instructed to 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 administered. The patient is advised to return in a week or 2 to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient's foot and the type of shoes the patient wears. It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position. There is also a new type of injection therapy known as alcohol sclerosing injections that uses denatured alcohol as an agent which scleroses the nerve. Injections are given every 7-10 days and may require 4-7 injections depending on the severity of the problem. There have been many published results on its effectiveness for the treatment of neuromas.

When conservative treatment does not work, minor surgery usually is necessary. There are many surgical procedures that are available. The first being the classical dorsal approach, it involves making an incision on the top of the foot. This approach permits the patient to walk soon after surgery because the stitches are not on the weight-bearing side of the foot. The podiatrist maneuvers the instruments carefully through many structures, cuts the deep transverse metatarsal ligament, which typically causes most of the nerve compression, and removes the neuroma. This procedure is one that Dr. Peng uses to remove large neuromas or for failed minimal incision surgery.

The second procedure involves a plantar approach, in which the incision is made on the sole of the foot. The patient must use crutches for about 3 weeks and the scar that forms can make walking uncomfortable. The advantage of the plantar approach is that the neuroma can be reached easily and resected without cutting any structures.

The third procedure is a procedure that uses a minimal incision technique. The advantage of this procedure is quicker recovery, but it is usually used for smaller neuromas. A special instrument is used to identify the deep transverse ligament and then uses a special blade to release this ligament. This will decompress the area allowing for the nerve to move more freely. The incision is located in between the toes and is hidden providing a more cosmetic result. Most patients report good relief of pain following surgery, but if pain persists a dorsal approach may be used in the future.

Surgical Complications with Neuroma Surgery

The surgical area contains very small blood vessels, nerves, and muscles and complications can occur. Once the neuroma is removed, the empty space may fill with blood, resulting in a painful hematoma. There is a risk for infection, necessitating careful monitoring by the podiatrist and patient. If the incision site becomes warm or red within a day or two after surgery, or if the patient runs a fever, the surgeon must be contacted immediately.

Recurrence is another possibility. The stump of nerve remaining after resection can begin to grow again. If this occurs, the nerve grows in width and length, creating a burning pain that can be treated by injection or further surgery. A very small percentage of patients also report having temperature/skin changes and pain out of proportion indicative of Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome. Dr. Peng may send you to another medical specialist for treatment if this complication occurs.