“Are arch supports the only way to treat neuroma?”
I was diagnosed with Mortan's neuroma recently, and I was only told to use an arch support in my shoes. But it doesn't seem to be working at all. Is this the only form of treatment available, or do you think I could get pharmaceutical treatment?
17 Answers
Although arch supports can certainly help patients with history of painful neuroma, it is not the only treatment. When the nerve along the interspace of your foot becomes irritated, a growth of nerve tissue occurs. This benign, non-cancerous, growth of nerve tissue in the foot (most commonly between the 3rd and 4th toes) is called a neuroma. The exact causes of Morton's neuroma are still not known. Best treatment option is to actually shrink the nerve growth. There are several ways of shrinking the growth which include cortisone and, my favorite, alcohol sclerosing injections. The sclerosing agent delivered to the nerve site will physically shrink the growth and remove the symptoms associated with painful neuroma. When all else fails, surgery to excise the neuroma is always an option.
Neuroma is a benign tumor of the digital nerves, which can be used by any compression to the area where the nerve bulge or adhere to another nerve or tissue. It's a simple procedure to remove neurons by laser or excision. If the neuroma's caused by foot imbalance, then orthotics might help, but I doubt it if the neuroma is inside the middle digits.
Morton's neuroma represents chronic inflammation with secondary scarring (fibrosis) around the nerve sheath or lining. It typically affects the common intermetatarsal nerve between the 3rd and 4th toes. Its cause may be traumatic, biomechanical induced, environmental (poor foot wear to include high heels, tight toe box), rheumatic (underlying arthritic disorder), and
idiopathic (no defined explanation). There are a variety of treatments to include shoe modifications, foot orthos with metatarsal pad to relieve pressure from the area, physical therapy, nerve block with corticosteroid, and finally surgery for either decompression or excision. There are other less investigated procedures to include ablations of nerve with chemical or
thermal probe and shock wave treatment.
Initial management includes shoe modification, metatarsal pad with or without supportive insole, activity modification and judicious use of anti inflammatory such as ibuprofen if permitted. If this does not produce improvement, I would recommend x-rays to rule out differential causes of pain to include stress fracture, joint disorder. Other imaging techniques for neuroma include ultrasound and MRI. If definitively neuroma then consider nerve block with cortisone and physical medicine. If this all fails, you may need to investigate more invasive treatment such as surgery and if this does not appeal to you some of the other less investigated approaches mentioned.
idiopathic (no defined explanation). There are a variety of treatments to include shoe modifications, foot orthos with metatarsal pad to relieve pressure from the area, physical therapy, nerve block with corticosteroid, and finally surgery for either decompression or excision. There are other less investigated procedures to include ablations of nerve with chemical or
thermal probe and shock wave treatment.
Initial management includes shoe modification, metatarsal pad with or without supportive insole, activity modification and judicious use of anti inflammatory such as ibuprofen if permitted. If this does not produce improvement, I would recommend x-rays to rule out differential causes of pain to include stress fracture, joint disorder. Other imaging techniques for neuroma include ultrasound and MRI. If definitively neuroma then consider nerve block with cortisone and physical medicine. If this all fails, you may need to investigate more invasive treatment such as surgery and if this does not appeal to you some of the other less investigated approaches mentioned.
Hello and thank you for your question. Conservative treatments for a neuroma include RICE, anti-inflammatories, OTC orthotics, custom orthotics, metatarsal padding, injections, specific foot exercises, wide shoe gear and if needed aggressive physical therapy. In only recalcitrant cases is surgery considered. Best of luck to you and God bless.
There are several ways to treat and neuroma. Arch supports are one way. You can try steroid injections, physical therapy, oral anti-inflammatory medication, alcohol sclerosing injections, and even surgery if necessary.
Jonathan M. Kletz, DPM
Jonathan M. Kletz, DPM
In my 40 years if practice, I have found that custom footborthoses are only a pirtion of the treatment. Other successful treatments include corticosteroid injections and therapeutic neurolysis via a 4% ethanol solution in marcaine for 5-8 treatments. This works mist of the time and the few thst do not respond require excision of the affected nerve.
Arch supports are needed to control the biomechanical force but doesn’t really treat the symptoms. I would recommend anti inflammatory medications. Typically a steroid shot at the neuroma helps considerably
Neuromas can be treated a variety of ways. They are a thickening of the nerve that runs between the toes. Cortisone injections can reduce scar tissue and provide some relief. If inserts are not effective, then surgical options can also be discussed. I recommend you discuss your options with a foot and ankle surgeon (podiatrist)
Arch supports or orthotics are a biomechanical way to treat a neuroma. They work by reducing the pressure on the metatarsal heads typically with added neuroma padding or metatarsal padding. However, a neuroma is an inflamed nerve, and the inflammation can be addressed via oral anti-inflammatories such as NSAIDs (ibuprofen, Aleve...) and/or with a cortisone injection.
A neuroma is an inflamed, scarred nerve. Structural support, of which there are various kinds, to alleviate pressure by the opposing bones is one way to treat neuromas. There are various ways to treat neuromas including physical therapy, taping, injections, padding, splints, orthotics, and surgery
An arch support is not the same as a custom orthotic. Custom orthotics are typically excellent for neuroma unless your shoe gear is too narrow. The initial neuroma pain usually responds well to injection, anti inflammatory medication, wider shoes and orthotics. If all of these fail the neuroma can be addressed surgically, however this will result in some permanent numbness which can be irritating. You should make an appointment to see your podiatrist to alleviate your pain.
Some years ago I published a paper on the treatment of neuromas. Conservative treatments with orthotics didn't seems to work at all. From a pharmaceutical treatment aspect, there was some success with injecting a corticosteroid or a sclerosis agent, usually alcohol.
The best treatment was to surgically excise the neuroma. It is a simple and easy procedure taking only a matter of minutes. I used an approach through the top of the foot allowing for immediate weight bearing,
The best treatment was to surgically excise the neuroma. It is a simple and easy procedure taking only a matter of minutes. I used an approach through the top of the foot allowing for immediate weight bearing,
No... that’s step one. If the orthotics had a metatarsal pad, good start. Next is a steroid injection. Surgically we can inject an alcohol solution to kill the nerve or surgically excise the nerve. Or even Dina decompression. Many many treatments. New one is called ossitron. I am not a fan, it will never work long term.
They are not. There are other options.
Arch support are a bio-mechanical method of treating Morton's neuroma. Other methods include cortisone injections or alcohol injections. Ultimately, most patients require surgical excision of the neuroma.
If the neuroma is inflamed and not responding to conservative treatment, an anti-inflammatory (ibuprofen, aleve, etc) or steroid injection may aid with pain relief. I would also avoid tight fitting shoes and high heels, which are known to cause neuromas more aggravation.
An arch support can help to alleviate neuroma pain and can help to prevent recurrence of a Neuroma AS LONG AS IT IS EQUIPPED WITH A WELL-POSITIONED METATARSAL PAD, which alleviates pressure from the metatarsal head region. However, there are many other ways to treat neuroma pain. In my practice, I start with the least destructive treatment, which would be a cortisone injection. From there, you have several, more invasive and destructive procedures. These include sclerosing injections to destroy the nerve, excision of the neuroma, or simple release of the ligament above the neuroma around the metatarsal head region, but this last surgical decompression often does not work.
