The 26 Review
- What is a Neuroma Inflamed or pinched nerve in the ball of the foot. Common between the 3rd and 4th toes
- Causes hereditary genes, trauma, poor shoe gear
- Symptoms Burning/shooting/electrical type pain, tingling or numbness between in the ball of the foot
- Diagnosis physical examination, X-Ray imaging (rule out a bone issue), MRI
- Treatment oral and topical anti-inflammatory medications, injections, shoe modifications, orthotics, surgery
Let’s take a closer look…
A neuroma (commonly referred to as a Morton’s Neuroma) is a noncancerous growth that forms on the nerve, usually between the toes. For example, it may be found between the third and fourth toes on one foot or between the fifth and sixth toes on the other foot. A neuroma generally causes pain and tenderness in the area where it develops. There are many different types of neuromas; some are less serious than others, depending on their cause and symptoms. If you’re suffering from persistent foot pain that doesn’t seem to get better, there could be a neuroma in your foot that’s causing your problem.
Neuromas are typically caused by compression or irritation of the nerve. One of the most common offenders is wearing tight fitting shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot structures and deformities including bunions, hammertoes, and flatfeet, are at a higher risk for developing a painful neuroma due to the increased pressure put on the nerves in the foot. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running. Direct trauma to the ball of the foot can also lead to nerve damage and inflammation.
A Morton’s neuroma’s pain can spread from the ball of the foot out to the tips of the toes. In some cases, there’s a sensation of a lump, a crease in your sock or a pebble that is stuck in-between the toes. You may have stinging, burning or numbness in the affected area as well. Due to increased pressure, standing for long periods of time can highly aggravate these symptoms. For most, neuroma pain can be temporarily relieved by taking off your shoes, stretching your toes and rubbing your feet.
People with certain foot deformities including bunions, hammertoes, and flatfeet, are at a higher risk for developing a painful neuroma due to the increased pressure put on the nerve. Based on the nature and location of your foot pain, physician clinical experience is an important tool in diagnosing a Morton’s neuroma. This takes multiple facets into account including your shoes, your medical history, and your common activities. For example, those who enjoy long walks, running, or outdoor activities may be susceptible to a Morton’s neuroma if they aren’t wearing the proper footwear. Specific testing done during the exam, such as compressing the toes together, can sometimes re-create the same nerve pain consistent with that of a neuroma. Additionally, foot X-rays are typically ordered to rule out other traumas or abnormalities with the adjacent bones such as a stress fracture. An MRI is also a consideration to further evaluate the surrounding soft tissue and bones of the foot in the event conservative treatments do not aid in relief of symptoms.
Treatment For a Neuroma
Treating nerve pain can always be challenging and results vary between patients. Initial treatment options for a neuroma include shoe modifications or new shoes, rest, oral and topical anti-inflammatories, Medical Grade Orthotics and specific forefoot padding. Custom Orthotics with special padding, such as a metatarsal pad, may be beneficial and a reliable first approach in treating nerve pain. Cortisone injections also provide immediate pain relief and can be very effective for long-term symptomatic relief. When these first line conservative options do not provide relief, Laser Therapy, Tens Unit applications, and alcohol sclerosing injections can offer an alternative approach for persistent and non-responding nerve pain. Finally, outpatient surgical removal of the painful nerve can be done when the above treatment does not suffice.