04/05/2021    Steve Tager, DPM

What is your primary treatment for Morton's neuroma? (Kenneth Meisler, DPM)

Maybe these posts about neuroma treatment are not
truly representative of what the nation’s
podiatrists do for this condition. While I am
reasonably certain that as physicians, we all try
to achieve positive outcomes and do that we feel is
mutually beneficial for our patients when it comes
to treatment regardless of the problem. Fifty plus
years of doing all that has been discussed, from
steroid injections, dehydrated alcohol, DTL
sectioning, excisions from both above and below,
etc., nothing compares to the success rate I’ve
experienced by simply reversing the pathomechanics
of lateral column overload. My experience continues
to tell me that restoring rearfoot function
anywhere close to anatomic neutral gives the foot
optimal opportunity to heal itself.

How many times have we sat in front of a pair of
feet and identified good upper and lower leg
alignment, with the plantar surface of both feet
trying to face each other? Is it not possible that
this, along with a few other structural and
functional variables to be determined, is the
etiology of neuroma development? And, once properly
and thoroughly evaluated, mechanically offloading
the lateral compression of the 3rd common digital
nerve, the inflammation and swelling producing the
symptoms subside. And yes, occasionally treatment
needs to be augmented by a steroid injection to
reduce the swelling of the neuroma that’s been
hanging around for a while. And yes, those lesions
that have found a permanent home in the foot may
need to be evicted. And yes, of course sclerosing
is an option along with the other treatment
options. However, is not a non-surgical, non-
invasive approach to the problem more appealing to
you as a patient if the outcome is beneficial?

It appears to me that all the above treatment
discussions are like treating a headache with pain
meds without knowing the cause. Consider if you
will, that the headache is caused by a tumor and
aspirin will not do the trick. Back pain produced
by leg length deficiencies aren’t best treated with
back surgery. Should we not be addressing the
primary cause? Then let’s see what happens to the
symptom.

For me, believing that the forefoot is directed by
the rear foot, I make a valiant attempt to
neutralize rearfoot function. Which, whenever
possible, allows for redistribution of weight
transmission thru the forefoot. A rear foot posted
orthotic has resolved most neuroma symptoms as
weight is shifted more medially offloading the
lateral column and avoiding compression of the 4th
metatarsal against the 3rd. Sounds simplistic?
Maybe so. But most patients in my practice don’t
object to using orthotics for pain relief just like
most people don’t mind wearing glasses.

Steven E. Tager, DPM, Scottsdale, AZ

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