A neuroma is an abnormal growth or tumor of nerve tissue that is often caused by pressure, injury, or irritation to a nerve, leading to thickening of the nerve tissue. The most common type is called a Morton’s neuroma, which typically develops between the third and fourth toes.
Neuromas present with several distinctive symptoms. The symptoms typically develop gradually, starting with pain only during certain activities or when wearing particular shoes, and eventually progressing to more persistent discomfort.
Signs and Symptoms of Neuroma
- Pain in the ball of the foot – Often described as burning, sharp, or shooting
- Tingling or numbness – Sensation that radiates to the affected toes
- Feeling of a “pebble” or “fold in the sock” under your foot when walking
- Pain that intensifies when wearing tight shoes or high heels
- Discomfort that improves when removing shoes and massaging the foot
- Pain that worsens with activity and improves with rest
- Clicking sensation when walking in some cases
Treatment Options
Conservative approaches, which are first-line treatment options, consist of:
- Footwear modifications – Switch to shoes with a wider toe box and lower heels
- Orthotic devices – Custom or over-the-counter metatarsal pads or arch supports to reduce pressure
- Activity modification – Temporarily reduce activities that place pressure on the forefoot
- Ice therapy – Apply ice to reduce pain and inflammation
- Anti-inflammatory medications – Over-the-counter NSAIDs can help manage pain and swelling
- Padding and taping – Specially placed pads can help spread the metatarsal bones and reduce pressure
- Rest – Giving your foot adequate time to recover
When conservative options fail, more invasive treatment options are considered. The aim of the interventions below are to either decrease the inflammation in and around the nerve or decreasing the size of the neuroma itself.
Medical Interventions
- Corticosteroid injections – Can provide significant temporary relief from pain and inflammation
- Alcohol sclerosing injections – A series of alcohol sclerosing injections that may reduce the size of the neuroma
- Physical therapy – Techniques to strengthen foot muscles and improve mechanics
- Ultrasound therapy – May help reduce inflammation around the nerve
Surgery is typically indicated when symptom relief is not achieved with the modalities above.
Surgical Options
- Neurectomy – An incision is made on the top or bottom of the foot and the aected nerve is surgically removed.
- Decompression surgery – An incision is also made on the top or bottom of the foot but rather than removing the nerve, the surrounding tissues are cut and removed in order to relieve pressure on the aected nerve.
Prevention is the best medicine!
- Always wear properly fitted shoes with adequate toe room
- Use arch supports or orthotics if you have flat feet or high arches
- Avoid high-heeled shoes or those with pointed toe boxes
- Rest your feet and wear proper sports shoes during high-impact activities
- Maintain a healthy weight to reduce pressure on your feet
Early diagnosis and treatment typically lead to better outcomes, so consult with a foot specialist if you experience persistent symptoms. Most people with neuromas can find relief through conservative treatments without needing surgery, with over 95% of people finding relief from conservative options.
Come see us at District Foot & Ankle for a proper evaluation and diagnosis so we can get you back to being a better you today!