Laser Treatment For Foot Neuroma

Do you always feel like there is a pebble caught in your shoe, right in the ball of your foot—but when you go to check, there is nothing there? You might have Morton’s neuroma.

In a sense, the condition really is not that different from standing on an actual pebble. Only instead of a pebble, it is a mass of thickened tissue surrounding a nerve in your foot—usually between the base of your third and fourth toes. And instead of being inside your shoe, it is inside your foot.

What is a Neuroma?

A neuroma is caused by the squeezing and irritation of a nerve fiber that provides feeling to the skin in between the toes. This nerve is located right underneath the ligament called the transverse intermetatarsal ligament in the ball of the foot. The nerve can get trapped with that ligament, causing unfortunate pressure on the nerve and triggering a reaction on the nerve which can lead to fibrosis and the thickening of the nerve.

What are the Symptoms of a Neuroma?

You probably will not be able to directly see or even feel a neuroma—there is no noticeable “lump” that you can find when you push on the area with your fingers. But when you put weight on your foot, the neuroma pushes uncomfortably against the nerve.

The thickened, fibrotic nerve ends up compressing the nerve cells, thus causing pain. The pain can become so severe that it prevents you from standing or walking properly. It can feel like a burning pain or like you are standing on a sharp pebble or stone, with the feeling often coming and going. A numbing or tingling in the toes may also come with the pain. However, in other cases of neuromas, some people do not have any symptoms at all.

What Causes Foot Neuromas?

It is not always possible to identify a specific cause for every situation. That said, in a more general sense, neuromas tend to develop as a response to an injury or constant irritation and pressure in and around the nerve tissue.

Risk factors linked with a higher risk of neuromas include:

• Wearing poor footwear: This is especially the case of wearing high heels and other styles that pinch the toes.
• High-impact activities: This includes running, sports, and even occupations that keep you on your feet all day.
• Foot structure: Your foot shape may naturally place excessive pressure on the front of the foot. This includes both “natural” inherited foot structures, as well as acquired deformities such as bunions or hammertoes.

How are Foot Neuromas Treated?

Too many people live with neuroma pain for far too long before finding the solutions that work best for them. Many other doctors normally treat neuromas with standard treatments such as cortisone injections or a minimally invasive procedure of cryotherapy or surgical treatment through a neurectomy. 

In most cases, corticosteroid injections provide temporary relief, lasting up to a few weeks. There are potential risks with corticosteroid injections, although side effects are unlikely to happen with one injection. Some reactions do happen, however, so you should keep this in mind if having corticosteroid injections. Some reactions include: 

• Experiencing the weakening of muscles and ligaments surrounding the injection site. which can lead to pain and instability. 
• The fat pad in the ball of the foot can shrink and lead to difficulty walking.
• The pigment of the skin can become lighter, which happens more in darker-skinned patients.

If injections failed to relieve pain, the next common option for most doctors will be to either do ultrasound-guided radiofrequency ablation (RFA) or ultrasound-guided cryoablation. 

Ultrasound RFA involves local anesthesia to numb the foot and a minimally invasive incision. Then the doctor or surgeon uses an electric current in controlled doses to heat soft tissues around the neuroma. The heat created is a result of radiofrequency probing which allows selective destruction of pain-transmitting nerve fibers so as to induce cell death, thus killing the nerve-transmitting cell. 

The ultrasound-guided cryoablation procedure on the other hand also involves local anesthesia and a minimal incision as well. However, the doctor or surgeon instead uses the insertion of a needle in order to freeze the neuroma at an extremely cold temperature.