CONDITIONS
PERINEURAL FIBROSIS (MORTON’S NEUROMA)
What is perineural fibrosis?
This condition, interdigital neuroma (Morton’s Neuroma) mainly affects the web spaces of the toes and creates compression of the digital nerve, between the metatarsal heads. Natural substances in-between areas of the forefoot can cause compression. The location of the pain is typically in the area between the third and fourth toes, but the pain can also present between the second and third toes.
What are the symptoms?
Most often, patients experience a burning, sharp, and tingling sensation in the front of the foot, sometimes on specific toes. Inappropriate shoe choices can worsen the pain, and pain is alleviated when the shoe is removed.
The symptoms present primarily due to the intrusion of the plantar nerve fibres, and the disorder is completely related to biomechanics.
How is a diagnosis made?
Dr Amir will examine the foot and the patient’s medical history to determine a diagnosis. This diagnosis can be easily confused with different conditions, such as a stress fracture, so it is necessary to have a proper evaluation performed.
What are the treatment options?
Non-surgical treatment primarily focuses on reducing inflammation and removing the cause of the compression to alleviate pain. Below are a few treatment options:
- Massage the area using anti-inflammatory gels
- Apply ice, focus on rest, and utilize elevation
- Only wear wide-fit shoes and avoid narrow shoes
- Injection therapy
When is surgery needed?
The most effective and widely accepted form of treatment for interdigital neuroma is surgery. Success rates for the proper surgery are above 80%. Surgery is incredibly effective because patients suffering from the problem have natural substances (fat, bony growths, etc.) that must be removed surgically to stop the compression of the nerve. Oftentimes, patients will experience numbness in the area post-operation, but this does not cause any discomfort and often improves in a few years.
There are various surgical techniques that Dr Amir will review when appropriate. Typically the surgery selected is performed under anaesthesia and allows for early weight-bearing post-operation. Oftentimes post-operation protective shoewear is assigned. Dr Amir will work closely with the patient’s podiatrist in providing appropriate orthotic therapy to address these biomechanical issues.
