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Morton’s Neuroma

By des | News

Morton’s Neuroma 

What is it?

Morton’s neuroma is a benign growth on the nerve that runs between the metatarsal bones and supply sensation to the toes. Most commonly, Morton’s neuroma develops between the 3rd and 4th metatarsal heads. When the growth gets compressed, between the metatarsal bones, it causes pain. Typically, the pain is on the ball of the foot and may radiate to the ends of the toes. “Nervy” symptoms such as shooting, tingling, burning, or zapping are common.

This condition usually develops because of microtrauma to the nerve. This microtrauma happens because there is not much space for the nerve to pass between two metatarsal bones (on either side of the nerve), the ground (underneath the nerve), and the deep transverse ligament (on top of the nerve). Add compression and pressure to an already small space and you have a recipe for Morton’s neuroma. Compression is added by tight or pointed footwear, heeled footwear, overpronation, generally wide feet, hammer toes and bunions (makes shoes tighter).

Diagnosis can be made clinically based on history, symptoms and in-clinic testing. Findings can be confirmed via imaging such as ultrasound or MRI.

So how do you treat it?

Firstly, it is best to talk to a foot specialist such as a chiropodist about your condition. You will be guided through treatment using conservative treatments first, then progressing based on how the foot responds. The goal is 80-100% resolution

Conservative treatments include general rest, activity modification to avoid aggravating activities, footwear changes to wider fitting shoes, and custom foot orthotics with metatarsal pads.

If conservative measures fail, there are injection therapies which are quite effective. Typically, cortisone injections are used first. Cortisone is a potent anti-inflammatory that can be injected into the area 1-3 times based on how symptoms react to the first injection.

If cortisone does not help, denatured alcohol injections are a logical next step. These injections are performed weekly for 4-7 weeks. Alcohol concentrations vary from practitioner to practitioner between 4-20%. The lower concentrations minimize risk of post-injection pain, so many practitioners opt to use 4% concentration. The goal of the alcohol injections is to gradually desensitize the nerve and reduce the size of the neuroma. These weekly injections are continued until complete resolution or until they are no longer making improvement.

If all treatments up to this point have failed, then surgery should be considered. There are two commonly performed surgeries. 1 – a neurectomy. A neurectomy is the surgical excision of the neuroma. Lasting side effects include numbness to the toes the nerve supplies (usually 3rd and 4th). The other surgery performed is a deep transverse ligament transection. In this surgery, the nerve and neuroma are left in tact. Instead, the deep transverse ligament is cut, which gives the nerve more space so it is no longer irritated. As with any injury, surgery should be considered last resort as there is higher chance of post-op complications such as infection and prolonged healing.

I hope this was an informative review of current practice guidelines on treating morton’s neuroma. If you have any pain on the ball of the foot, be sure to contact a chiropodist for an assessment and treatment.

 

This blog was written by Jake Cahoon and is not necessarily the opinion of The Footcare Centre.

 

COVID-19 Precautions

By des | News

COVID-19 precautions at The Footcare Centre 

In this new normal we live in, there are changes to almost every public procedure we do, all in the name of safety. By now we are getting used to using masks, social distancing, washing our hands plenty, keeping our hands off our faces and overdue haircuts.

At The Footcare Centre, we have been working hard to make sure our patients are safe while they get the care they need. Over the last 4 months we have transformed our clinic and procedures to reflect new guidelines for COVID-19. Some of these changes include, scheduling patients so there is minimal contact in the office, having multiple pre-appointment screens, having all patients wear face masks, and having all patients wash hands upon entering and leaving their appointment. Chiropodists and front staff have increased PPE as well. All staff wear face masks, and during treatment, chiropodists wear face shields, aprons and gloves.

The clinic itself has changed. Plexiglass windows now separate the front desk staff from patients, and cubicles in the waiting room separate patients from other patients. 1-way flow has been established to minimize close contact.

Multiple COVID-19 screens over the phone and in person have been put in place. All these procedures help keep you safe while visiting the Footcare Centre. As we proceed through this everchanging lifestyle of COVID-19, The Footcare Centre keeps your safety at the top of its list. We will all get through this together.

Foot Art

By des | News

Amazing Foot Art

For Father’s Day, my 1-year old daughter “made” me a card with a paint print of her foot as a golf bag, and the toes were clubs. It looked really good! It got me wondering what kind of amazing art has been made with feet. After a bit of research I found numerous artists who do amazing work. In fact, there is an organization for artists who pain with only their feet and/or mouth. It’s called The Foot and Mouth Painting Artists Association. Check out these links to some incredible art pieces from artists who draw and paint with only their feet!

https://www.youtube.com/watch?v=8Mtxh_ERVUU

https://www.youtube.com/watch?v=5FHllrGEGoo

https://www.youtube.com/watch?v=YrPA0K4ykcU

 

This blog has been written by Jake Cahoon and is not necessarily the opinion of The Footcare Centre.

The role of surgery in the management of foot conditions

By des | News


The role of surgery in the management of foot conditions 


It is common, that over time, the effectiveness of a treatment in the  treatment management of a condition can change.  


Care pathways exist so that patients and clinicians know when to proceed to the next treatment option or the next level of treatment strategy. Treatment pathways are usually based upon evidence.  There is often research or experiential evidence to suggest the appropriateness of one particular treatment over another, however they can be fluid enough to allow them to be tailored individually and flexibly to a patient’s individual circumstances.

 

Sometimes, despite best efforts, some conditions may not respond to treatments as hoped, and a patient may move through a treatment pathway in order to successfully treat their condition.


In many treatment pathways surgical interventions are placed towards the end of a treatment pathway (lets rule out broken bones and other types of emergency surgery here), where other more conservative options have been explored and a patient begins to seek a more radical treatment option.


Examples of surgical treatments include minimally invasive procedures using the Koby system to treat two conditions that are frequently seen: Morton’s Neuroma and plantar fasciitis. Minimally invasive surgical options can be undertaken under local anesthetic as outpatient procedures in the office and can be used when traditional conservative treatments fail to provide satisfactory outcomes for a patient.  A small incision is used to access either a small ligament near the Morton’s neuroma or the plantar fascia. With Morton’s neuroma the system is used to locate and precisely cut a small ligament to offer decompression to the neuroma, whilst with plantar fasciitis the plantar fascia is located and a partial fasciotomy can be performed.


Whilst surgical options may remain a more radical option, it is useful to have options available to patients when other treatments fail.