A neuroma (most commonly Morton’s neuroma) is a painful condition affecting the ball of your foot. It occurs when tissue thickens around a nerve, typically between the third and fourth toes, causing pain, burning, tingling, and numbness.
What triggers neuroma?
It occurs when the nerve between the toes becomes compressed or irritated, leading to pain, numbness, or tingling in the affected area. Neuromas can affect anyone, but they are most commonly found in highly active individuals and individuals who wear high heels.
Diagnosing neuromas
Diagnosis involves a combination of clinical evaluation, patient history, and diagnostic tests. Physical exam findings consist of feeling a tender nodule or mass and applying pressure to the area to reproduce the pain. Another key clinical exam finding is Mulder’s click. This is a clinical sign where the examiner compresses the metatarsal joints together while simultaneously squeezing the foot in a side-to-side direction. If a clicking or popping sensation is felt and the patient’s pain is reproduced, this is suggestive of a Morton’s neuroma.
While Morton’s neuroma is primarily diagnosed based on clinical symptoms and physical examination, imaging studies can help confirm the diagnosis or rule out other conditions:
- X-rays: These are typically normal, but they can help rule out other causes of foot pain, like fractures or arthritis.
- Ultrasound: High-frequency ultrasound can be used to visualize the neuroma directly.
- MRI: An MRI can reveal a mass or enlargement of the nerve.
How are neuromas treated?
Treatment is typically non-operative, with 95% of neuromas being managed without surgery and improving with non-operative measures.
Here’s a comprehensive approach to treating neuroma pain and preventing recurrence:
Immediate Pain Relief
- Rest and avoid aggravating activities – Reduce high-impact activities and pressure on the affected foot
- Ice therapy – Apply ice to the painful area for 10-15 minutes several times daily
- Over-the-counter pain relievers – NSAIDs like ibuprofen can reduce pain and inflammation
- Proper footwear – Switch to shoes with a wide toe box and low heels
Conservative Treatment Options
- Shoe modifications – Wear shoes with adequate room in the toe area and proper arch support
- Orthotic devices – Custom or over-the-counter shoe inserts that reduce pressure on the neuroma
- Padding techniques – Metatarsal pads strategically placed in footwear can spread the bones to reduce pressure
- Activity modifications – Temporarily avoid activities that put pressure on the forefoot
Medical Treatments
- Corticosteroid injections – Can provide significant temporary pain relief
- Alcohol sclerosing injections – Series of injections that may reduce the size of neuromas
- Physical therapy – Can help strengthen foot muscles and improve foot mechanics
Surgical Options
For severe cases that don’t respond to conservative treatment, surgical options include:
- Neurectomy – Removal of the affected nerve
- Decompression surgery – Cutting nearby structures to relieve pressure.
Prevention is always key!
- Proper footwear – Always wear shoes with adequate toe room and proper support
- Avoid high heels – Limit wearing high heels to reduce pressure on the forefoot
- Maintain healthy weight – Extra weight increases pressure on your feet
- Proper exercise shoes – Use appropriate footwear for specific activities
- Foot exercises – Stretching and strengthening exercises for foot muscles
If you’re experiencing persistent foot pain, consult a podiatrist for proper diagnosis and treatment. Early intervention typically leads to better outcomes and may help you avoid surgery. Come see us at District Foot & Ankle so we can get you back to being a better you today!