Botox? Surgery? What’s the Best Treatment for Morton’s Neuroma?

Robert G. Parker
Connect with me
Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.


Morton’s neuroma is a very common condition that can cause pain, tingling, and sensitivity in the front part of the foot. If you constantly feel like you’ve got something stuck in your shoe, jabbing you near the base of the second, third, or fourth toes, there’s a good chance Morton’s neuroma is to blame.

Nerves

Morton’s Neuroma: A (Very) Quick Overview

Nerves are long, narrow fibers that extend throughout your body, connecting tissues, muscles, and organs to the central nervous system and the brain. Often, they have to wind through tight tunnels and spaces in your body where they can be easily injured, pinched, or compressed. This is the case with the common plantar digital nerve, where it runs through the ball of the foot.

When the nerve gets compressed in this area, the tissue thickens, becoming swollen and irritated. That mass of tissue presses against the nerve, causing pain. Without taking corrective action, the problem tends to get progressively worse over time.

Morton’s neuroma can be caused by a variety of factors. Sometimes your own inherited foot structure conspires against you, leaving you predisposed to the condition. Other cases might be traced to poor footwear choices, pre-existing deformities (such as bunions), or repetitive pressure from sports, hobbies, or occupations that require you to be on your feet.

Investigating the Treatment Options

As with many foot conditions, there are a number of treatment options available for Morton’s neuroma. These include both conservative and surgical remedies, from the “tried and true” to more novel approaches.

Can Morton’s Neuroma Be Treated with Botox?

This is one of the more interesting new treatment options we’ve seen. Botox—specifically botulinum toxin A—is of course best known for its use as a cosmetic facial treatment. It’s also been used to treat certain hyperactive nerves, spastic muscles, migraine headaches, and some other disorders.

Because Botox works by blocking a specific neurotransmitter (acetylcholine), it can be very useful for the management of some types of neuropathic pain. A few years ago, a study published in the Clinical Journal of Pain revealed some encouraging results when Botox was used to treat Morton’s neuroma symptoms in 17 patients.

What Happened?

According to the study authors, more than 70% of the patients who received the treatment were satisfied with the results. All of them had been experiencing chronic Morton’s neuroma pain for at least three months.

Most reported that the effects of the treatment were already apparent within the first few days, and within a month there was significant improvement in their symptoms as well as their level of mobility and functioning. None reported worsening symptoms. The improvement in symptoms lasted up to three months in some cases.

Podiatrist

So, Is Botox the Right Treatment for Me?

While the early studies are encouraging, we’re not ready to give this treatment our full support quite yet, for a number of reasons. While Parker Foot & Ankle prides itself on investing in the most cutting-edge technology and research to give our patients the widest array of treatment options—Dr. Parker is “Houston’s High Tech Podiatrist” for a reason—the scientific study of Botox for neuromas is still very much in its infancy. Again, while the results of one study are promising, it’s still only one study, and statistically speaking, 17 patients just isn’t a big enough sample to be truly confident in the results.

Another important consideration is cost to our patients. If there’s an insurance provider anywhere on planet earth that will cover Botox injections for a Morton’s neuroma, we haven’t seen it yet. Furthermore, the effects of treatment are only temporary and may need to be repeated several times every few months. However, there are many other treatment options available that most insurances will cover. Some of these are also highly effective, with a much more robust body of research to support them.

Other Treatment Options for Morton’s Neuroma

The best treatment for Morton’s neuroma depends on the specifics of your condition. How long have you been suffering from pain? How severe are your symptoms? How is your neuroma affecting your day-to-day living? What treatment options have you already tried? What is the root cause of your neuroma? The answers to these and other questions will help shape the treatment approach.

For example:

  • Improved footwear. Many cases of Morton’s neuroma result from wearing high heels or ill-fitting shoes. Often, switching to wider, more comfortable shoes that fit you properly will alleviate the discomfort.
     
  • Shoe inserts. Depending on level of support your feet require, we may recommend simple metatarsal pads, prefabricated insoles or arch supports, or even custom orthotics to relieve the painful pressure on the neuroma.
     
  • Radiofrequency nerve ablation. This treatment uses guided electrical currents to heat up a small portion of the nerve sheath at the site of the neuroma. This disables the nerve’s ability to sense pain within that area. The nerve only needs to be heated for about 90 seconds for the treatment to be effective.
     
  • Injections. While Botox may not be the No. 1 injection choice at our practice just yet, other injections with a longer track record of success may be selected instead, such as corticosteroids or platelet-rich plasma.
     
  • Other high-tech alternatives to surgery. Depending on your situation, we may consider other advanced regenerative medicine techniques or laser technology to reduce pain and swelling and accelerate natural healing.
     
  • Surgery. If conservative therapies have been exhausted or ruled out, Dr. Parker will correct the problem with a surgical procedure. Often, we will be able to relieve the pressure by cutting or releasing neighboring ligaments, tendons, or other structure. In other cases, we may determine that it’s better to cut out and remove the neuroma entirely. Either way, the incision is made on the top of the foot for better post-surgical healing.

As you can see, we offer a comprehensive range of treatment options to address your Morton’s neuroma pain as quickly and effectively as possible.

To schedule an appointment with Dr. Parker in Houston, give our office a call today—or contacts online using our appointment request form.

Be the first to comment!
Post a Comment