TREATMENT
After your evaluation, your physician will discuss the most appropriate care for your neuroma. Treatment begins with conservative padding and strapping of the foot. Some specific treatments include:

Conservative treatment:
Functional Orthotic Devices- Custom shoe inserts reposition your body weight across the metatarsal area, thereby decreasing abnormal pressure on the neuroma, helping to prevent nerve irritation.

Sclerosing Injections:
Sclerotherapy- is a procedure which involves the injection of a sclerosing agent (causes scarring) into a particular area/site of the body. Sclerosing injections have been used for many years in the treatment of varicose veins, and also in the throat and liver.

Sclerosing treatments for MN involve the use of a mixture of a local anesthetic called marcaine, and anhydrous alcohol. These two ingredients are combined to create a 4% alcohol solution. .5 cc's (one-half of a cc) is injected into the nerve a few centimers proximal to the tumor. The 4% alcohol solution chemically inactivates the nerve. This prevents the transmission of the pain sensations that are associated with MN.

There are a number of different protocols used in sclerosing treatments for MN. The protocol I currently utilize is a series of 7-10 weekly injections. At the end of the 5th treatment, if the patient has had any noticeable improvement, anywhere from 7 to 10 (total) weekly injections are given, depending on individual patient response.

Sclerotherapy is not for every patient with MN, nor will every patient respond to this type of treatment. However, with the choice of either living with the pain and disability of MN, or electing to undergo surgical excision, I find this type of treatment to be an excellent alternative.

Physical therapy
*Ultrasound Therapy and Hydrotherapy-Whirlpool theurapeutic treatments coupled with sound waves (ultrasound) may help reduce swelling around the nouroma.

*Medication - Cortisone injections or other medication can relieve pain and swelling in the nerve's outer costing.

* Shoe Modifications - Pads can cushion and support the parts of your foot that are vulnerable. Roomy, supportive shoes can help prevent irritation. A change to a more wider shoe can also decrease the pressure on the offending nerve.

*Padding and strapping- Adhesive tape with a combination of adhesive strapping may also be used in conjunction with the above conservative treatment to decrease pressure on the affected nerve

Surgery:
The decision to surgically intervene is based on your symptoms and the judgement of the doctor. If nonsurgical care does not give sufficient relief, surgery may be necessary to remove or decompress the neuroma. A local anesthetic may be used for this procedure, which can be performed in a physician's office, surgical center or hospital. Following surgery, you may feel numbness in the area where the nerve was removed. Your physician will tell you how soon you can be on your feet, but generally you may return to normal activities within three to six weeks.