What is a Neuroma?
A neuroma is a painful condition that affects the nerve tissue in the foot. It typically occurs between the third and fourth toes (Morton’s Neuroma), although it can also occur between the second and third toes. A neuroma is caused by a thickening of the tissue around one of the nerves that leads to the toes. This can be caused by repeated irritation or compression of the nerve, which can be due to factors such as wearing tight or narrow shoes, engaging in high-impact activities that put stress on the feet, or having certain foot deformities.
Symptoms of a neuroma include pain, burning, tingling, or numbness in the ball of the foot or the toes. The pain may be worse when walking or standing and may feel like there is a pebble or marble in the shoe. In some cases, a neuroma can cause a feeling of pins and needles or a sharp shooting pain in the toes.
What are treatment options for Neuroma?
The treatment options for a neuroma depend on the severity of the symptoms and the degree of functional impairment. Conservative measures are usually the first line of treatment and may include:
Shoe modifications: Wearing shoes with a wider toe box and lower heels can reduce pressure on the affected nerve and provide more room for the toes and your foot splay.
Orthotics or arch supports: Custom-made shoe inserts can help to redistribute pressure on the foot and provide better support. At PS Foot and Ankle we can create specific accommodations within your orthotics to help with neuroma relief by offloading that area.
Medications: Over-the-counter pain medications, such as ibuprofen or acetaminophen, can help to reduce pain and inflammation. These medications cannot shrink the neuroma, but will help alleviate associate soft tissue pain
Corticosteroid injections: Injections of corticosteroids into the affected area can help to reduce inflammation and relieve pain. These injections will not shrink the neuroma, but will provide relief to the surrounding the soft tissue.
Physical therapy: Stretching and strengthening exercises can help to reduce pain and improve mobility of the smaller intrinsic muscles of the foot.
If conservative treatment fails to provide relief, surgical intervention may be necessary. Surgical options include:
Nerve decompression: This involves releasing the ligament (deep transverse metatarsal ligament) that is compressing the nerve and removing any thickened tissue around the nerve.
Nerve excision: In some cases, it may be necessary to remove the affected nerve. This can lead to numbness in the affected area, sometimes changes of possible recurrence of the neuroma, but if the neuroma is large enough it can provide relief from pain. MRI imaging required prior to surgical assessment.