Neuroma

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Feel like there's a pebble in your shoe?

Q & A

What is a Neuroma?

The term neuroma is actually a misnomer because although neuroma means a benign nerve tumor, a neuroma is not actually a tumor. Rather it is a benign thickening of the tissue surrounding nerves and frequently affects the nerve found between the third and fourth toes, called a Morton’s neuroma. It causes pain in the ball of your foot, and can be described as a burning sensation, tingling, or numbness between the toes and in the ball of the foot.

Causes

Although the exact cause for this condition is unclear, a number of factors can contribute to the formation of a neuroma:

Improper footwear that causes the toes to be squeezed together is problematic. Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.
Repeated stress, common to many occupations, can create or aggravate a neuroma.
Biomechanical deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition.
Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve.

Symptoms

If you have Morton’s neuroma, you may feel like you’re standing on a small rock that’s caught in your shoe, except the rock does not move. Surprisingly, despite causing this feeling, Morton’s neuroma doesn’t result in a lump or have any visible signs. Other symptoms of Morton’s neuroma include:

Pain in the forefoot and between the toes
Tingling and numbness in the ball of the foot
Shooting pains
A burning sensation
Discomfort that worsens while walking or wearing tight shoes

Diagnosis and Treatment

The diagnosis of a neuroma is often based on symptoms and physical examination, sometimes requiring imaging modality such as ultrasound or MRI.

Non-surgical treatment options which include:

Shoe gear modification- A pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms
Padding and taping- Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma.
Custom orthotics to control foot function and reduce symptoms
Medications- Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the neuroma.

The primary goal of non-surgical treatment regimens is to relieve pressure on areas where a neuroma develops.

Surgical Options: If non-surgical treatments are not effective at reducing your symptoms, surgery may be an option. The procedure involves removing the inflamed and enlarged nerve, and is done on an outpatient basis, with a recovery time that is often just a few weeks.

Prevention

Although the exact causes of neuromas are not completely known, the following preventive steps may help:

Make sure your exercise shoes have enough room in the front part of the shoe and that your toes are not excessively compressed.
Wear shoes with adequate padding in the ball of the foot.
Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).

Content credit: apma.org

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