| One-Minute Clinician

Morton's Neuralgia: Small Nerve, Big Problems!

Morton’s neuralgia, as it turns out, is not a true growth of the nerve, but is a compression-type injury of the peripheral nerve as it is in the plantar aspect of the foot, heading out towards the toes. It produces some remarkable symptoms that have folks limping in through the door. The diagnostic options are fairly limited because it’s such a small peripheral nerve that causes such a big problem. MRIs and ultrasounds, while they can see the nerve if it’s enlarged more than 5 or 6 mm, can’t see it when it is smaller than that. And so the physical exam becomes the key part of diagnosing Morton’s neuralgia.

The conservative care that seems to work best is altering the shoe gear and trying to avoid the pinching of the nerve. If we bear in mind that the nerve is compressed, we try to uncompress the nerve by utilizing some sort of external forces. Unfortunately, the results with other conservative care--be it foot orthosis or specialized inserts that go inside shoes, injections, alcohol, steroids--the results are not enduring. They don’t last and folks end up in the operating room in many cases,

Most of us have been taught that the goal of surgery is to excise the nerve. And yet, there’s nowhere else in the body that we excise a compressed nerve. We uncompress the nerves. When we look at the results of excision of the nerve, it’s fraught with complications. You’ve now created a numb area on the foot, and the patient is now at risk for injury that they’re not aware of. We also find that once that you cut the nerve, of course, you’d form a true neuroma, and those two neuromas become painful. By contrast, if you decompress the neuroma, take the pressure of the neuroma, much like you would in carpal tunnel syndrome, the results are much better. And so a big part of my goal as I speak about this around the United States is to tell folks, “Quit removing compressed nerves. Decompress the nerve.”

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