Morton's Neuroma

Eugene P. Toomey, M.D.

Interdigital neuroma (Morton's neuroma) is a relatively common problem of the foot. The digital nerve traveling between the toes becomes entrapped just before it separates into two separate nerves to supply sensation to the toes. There is no known cause for this condition but tight fitting shoes, trauma to the foot, and anatomic abnormalities all appear to contribute. Once the nerve becomes entrapped and swollen it will develop a small pea sized bundle of tissue described as a neuroma. This is demonstrated in the picture below.

Patients can usually be fairly precise about the location of the pain. It is described as a pain between the toes that radiates out into the webspace. Often times, if the patient steps just right on the foot, they will describe a "zing" that radiates out into the toes. Most commonly this is found between the third and fourth toes (80-90% of the time). The other 10-20% is seen between the second and third toes. Rarely does the condition affect more than one webspace at a time or other webspaces.

There are many treatments for this condition ranging from a modification of shoe wear to surgery. Initially, patients should try pads, such as a hapad, to take pressure off the nerve. Shoe wear should not be tight and high-heeled shoes should be avoided. If simple modalities do not help the condition, then a cortisone injection into the nerve can be done. This probably should not be done more than twice as it can weaken the ligaments around the toe and cause some loss of the fat pad in the bottom of the foot. When these non-operative treatments fail, surgery can be done to remove the neuroma.

The picture above is a photo taken at the time of surgery. The surgeon has made a small incision in the third webspace and with slight pressure on the bottom of the foot the neuroma comes into view. Once the neuroma is removed, the patient will have some permanent numbness on the sides of the toes for that particular webspace. This is rarely bothersome to the patient, as they are so happy to be rid of the intense pain caused by the neuroma.

SOFC Adds Dr. Eugene P. Toomey

Please welcome the latest addition to our physician staff, Dr. Eugene P. (Pepper) Toomey, who started in April this year.

Dr. Toomey takes care of all aspects of orthopedics but has a special interest in problems of the foot and ankle. In 2000, Dr. Toomey went back to Baltimore to train with Dr. Mark Myerson (chairman of foot and ankle reconstruction at Union Memorial Hospital) in complex reconstruction of foot problems. During his residency, he also worked with the late Ken Johnson, M.D. who was the head of orthopedic foot and ankle at the Mayo Clinic in Rochester, Minnesota. Dr. Toomey is a member of the Academy of Orthopedic Surgeons Foot and Ankle Society. He is also a member of the Prescription FootWear Association. Dr. Toomey has given many lectures on foot and ankle problems as well as now developing a device to improve bunion surgery. In addition to foot and ankle, Dr. Toomey has extensive experience in total joint replacement surgery, sports medicine and fracture management.

Dr. Toomey grew up in North Dakota. He attended college and graduated Magna cum Laude from the University of North Dakota. He also graduated from medical school there and was one of five students in his class to spend their third year at the Mayo Clinic. After graduating from medical school, Dr. Toomey did his five year orthopedic residency at the Mayo Clinic. Following completion of his residency in 1986, Dr. Toomey did a fellowship in trauma with the Association of Osteosynthesis in Davos, Switzerland.

Dr. Toomey started his practice in North Dakota and then married his wife, Laureen, who grew up in Seattle. As Dr. Toomey puts it, "If you marry a girl from the state of Washington, you are going to move to Washington." Initially, he started his practice in Wenatchee and practiced there for nine years. During his time in Wenatchee, he served as Chief of Staff at Central Washington Hospital for two years. Wanting to be closer to family, the Toomey's decided to move to Seattle in 1999. Dr. Toomey started practice with Virginia Mason in their Federal Way clinic doing general orthopedics. Seattle Orthopedic and Fracture Clinic offered Dr. Toomey a position to do primarily foot and ankle surgery and he accepted this in January, 2000.

Besides the above societies, Dr. Toomey is Board Certified and a member of the American Board of Orthopedic Surgery. He is also a member of the American Medical Association, Washington State Medical Association, AO Fellows Association, and the American Academy of Orthopedic Surgeons. Dr. Toomey has two girls: Alyssa, 11, and Glenna, 8. They reside on Mercer Island. Besides medicine, Dr. Toomey's interests include golf, skiing, and flying.

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