A neuroma is a thickening of nerve tissue that can develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes. It can also be referred to as an intermetatarsal neuroma. Intermetatarsal describes its location in foot between the metatarsal bones. Neuromas can also occur in other locations in the foot.
The thickening/enlargement, of the nerve that defines a neuroma is a result of compression and irritation of the nerve. This compression causes enlargement of the nerve, and can lead to permanent nerve damage and pain.
Causes
Compression/irritation of the nerve leads to the development of a neuroma. Shoes with a small/narrow toe box or high heel shoes cause the toes to be pushed together. At times patients with foot deformities (i.e. bunions, hammertoes, flatfeet, or flexible feet) are at risk for developing a neuroma. Sporting activities that involve repetitive irritation to the ball of the foot can also predispose the foot to neuroma.
Symptoms
- Tingling, burning, or numbness in the forefoot
- Continued Pain
- Feeling that something is inside the ball of the foot
- Feeling that something is in the shoe or a sock is bunched up
Symptoms begin gradually, when wearing narrow-toed shoes or performing certain activities the symptoms occur once in a while. Symptoms may go away temporarily by removing the shoe, massaging the foot, or by avoiding aggravating shoes or activities. Over time the symptoms worsen and persist. Symptoms become more intense as the neuroma enlarges and then the temporary changes in the nerve become permanent.
Diagnosis
To arrive at a diagnosis, your surgeon will obtain a thorough history of your symptoms and examine your foot. During the examination, your surgeon attempts to reproduce your symptoms by pushing over the area or manipulating the foot.
X-rays are ordered to evaluate any bony abnormalities. Often times the neuroma will cause the toes to splay or separate. An MRI or Ultrasound may be ordered to determine the extent of the pathology to the neuroma as well as determine surgical planning should surgery be warranted.
Non Surgical Treatments
In developing a treatment plan, your surgeon will determine how long you have had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.
For mild to moderate neuromas, treatment options may include:
- Padding. Padding techniques provide support for the metatarsal arch, and lessen the pressure on the nerve and decreasing the compression when walking.
- Avoid barefoot. When you walk without shoes, you put increase strain and stress on your neuroma.
- Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation.
- Limit activities. Reduce physical activities until symptoms improve.
- Shoe modifications. Wearing supportive shoes that have good support reduces stress on the neuroma.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
- Orthotic devices. Custom or over the counter orthotic devices that fit into your shoe help correct and stabilize the underlying structure of the foot.
- Shoe modification. Shoes that have a rigid or semi-rigid sole.
- Injection therapy. In some cases, corticosteroid injections or alcohol injections are used to help reduce the inflammation, decrease the size of the nerve and relieve pain.
- Exercises. Stretching exercises help relieve tension from other conditions that put stress on the neuroma such as a tightened Achilles tendon.
- Physical therapy. Physical therapy may include strengthening exercises, soft-tissue massage, mobilization, ambulation education, stretching, and ultrasound therapy to reduce inflammation.
Surgery
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