What Is A Neuroma?
A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a painful benign enlargement and scarring of an interdigital nerve branch commonly occurring in the ball of the foot typically between the 3rd and 4th metatarsals, which is referred to as a Morton’s Neuroma. Neuroma’s commonly present as a sharp stabbing pain often with burning, tingling or numbness sensations in the ball of the foot with radiating symptoms into the toes. The principal symptom associated with a neuroma is sharp pain in the ball of the foot and into the toes worsened with walking or running. Individuals suffering from neuroma’s often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe. Neuroma’s are most common in women partly due to wearing high heeled shoe gear with tapered toe box.
There are a number of factors that contribute to the formation of a neuroma:
1. 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 abnormal pressure across the ball of the foot.
2. Repetitive trauma from walking and abnormal motion and pressure across the forefoot can cause damage to the delicate nerves in the ball of the foot, resulting in inflammation, swelling and often scarring of one or more of the nerve branches.
3. Improper footwear can causes the toes and forefoot together. Avoid high-heeled shoes higher than two inches. Shoes at this height significantly increase pressure on the forefoot area.
4. Repetitive stress on the ball of the foot, common to many occupations, can create or aggravate a neuroma.
The symptoms of a neuroma include the following:
1. Pain in the forefoot and between the toes.
2. Tingling and numbness in the ball of the foot radiating into toes.
3. Swelling between the toes.
4. Pain in the ball of the foot when weight is placed on it.
What can you do for relief?
1. Wear shoes with low heels and plenty of room for the toes to move.
2. Wear shoes with thick, shock-absorbent soles, as well as proper insoles that are designed to keep excessive pressure off of the foot.
3. High-heeled shoes over two inches tall should be avoided whenever possible because they place undue strain on the forefoot.
4. Resting the foot and massaging the affected area can temporarily alleviate neuroma pain.
5. Use an ice pack to help dull the pain and improve comfort.
6. Use over-the-counter shoe pads. These pads can relieve pressure around the affected area. Your podiatrist will usually have these available in the office.
When to Visit a Podiatrist:
You should schedule with your podiatrist at the first sign of pain or discomfort. If left untreated, neuromas tend to get worse and more difficult to resolve.
Diagnosis and Treatment:
Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical intervention. For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, additional treatment or surgery may be necessary to remove the tumor. The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops. Your podiatrist will examine and likely X-ray the affected area and suggest a treatment plan that best suits your individual case. Additional non-surgical treatment opttions may include:
1. 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.
2. Medication -Anti-inflammatory drugs can be prescribed and your podiatrist can provide you with cortisone injections to ease acute pain and inflammation caused by the neuroma.
3. Orthotics -Custom shoe inserts made by your podiatrist may be useful in controlling foot function. Orthotics may reduce symptoms and prevent the worsening of the condition.
When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Your podiatrist will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.
Although the exact causes of neuromas are not completely known, the following preventive steps may help:
1. Make sure your exercise shoes have enough room in the front part of the shoe and that your toes are not excessively compressed.
2. Wear shoes with adequate padding in the ball of the foot.
3. Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).