Neuroma or Morton’s Neuroma are common conditions that afflicts the forefoot. They can be painful and debilitating. They are characterized by a numbness that translates to the second or third toe, as well as the feeling of there being a lump in your foot. Neuroma surgery, however, is a surgery that is performed far too commonly, and neuromas tend to be over diagnosed. What follows is the five best questions you should ask your Podiatrist before having Neuroma surgery performed.
5. Are you sure this is a Neuroma? Neuromas are the most over diagnosed condition of the forefoot that can emulate many other conditions. They also are a simple operation that reimburses well for minimal work. This contributes to the over diagnosis of Morton’s Neuromas and Neuromas in general. The most common syndrome that mimics Mortons Neuroma is Pre Dislocation syndrome. This is characterized by the toe next to the Neuroma slowly dislocating from its joint causing pain that mimics a Neuroma. Signs that you are suffering from PDS would be if the foot has a bunion on it, or hammer toes. In those cases you most likely do not have a Neuroma, and would probably benefit more from bunion surgery or hammer toe surgery. Additionally, there are pads that can also be effective in treating PDS. I have provided links to such pads at the end of this paragraph. Another, sign you do not have a Neuroma is if the Podiatrist wants to remove more then one neuroma at a time. Multiple Neuromas do not occur in the same foot. If a Podiatrist is telling you that you have multiple Neuromas, then you need to see another Podiatrist.
4. Have we done all the conservative care to cure the Neuroma that is possible? Neuromas, when they are present, typically respond very well to conservative therapy. Conservative therapy that should be attempted on a Mortons Neuroma before surgery include cortisone shots, padding as above, wider shoes or taking Motrin regularly. All these options should be exhausted before having Neuroma surgery.
3. What kind of Neuroma surgery are you performing? There are multiple kinds of Neuroma surgery out there. One kind of Neuroma surgery is to excise the nerve completely. This is very common surgery done through an incision on the top of the foot. It is also, an older procedure that results in many complications such as a Stump Neuroma. Also, Neuromas can be very difficult to visualize and most doctors will have a hard time locating the Neuroma during the procedure. There is a superior operation. It is a decompression operation similar to Carpal Tunnel Syndrome. One of the causes of Neuromas tends to be a ligament crossing over the nerve rubbing against the nerve causing swelling and damage. A simple clip of this ligament can take care of most of the symptoms of a neuromas. This also has a much lower rate of complications and is only a three to five minute operation
2. How many Neuroma surgeries do you do a month? Normally, you would want your surgeon to do a lot of neuromas a month. Not in this situation. Any Podiatrist or surgeon who does more than five neuroma surgeries a month is over diagnosing them, and you should see somebody else. Neuromas are a rare diagnosis and you need to see a surgeon you can trust. Surgeons doing a lot of neuroma surgeries are not trustworthy.
1. Will I have to be off my foot for any length of time or be laid up? Neuroma surgery is a simple surgery so the answer to this question should be you will be able to walk home. But you never know. There are many variances around Neuroma surgery, but you will need a clarification of this question.