Neuroma

What is a Neuroma?

A neuroma is usually described as a growth or a benign nerve tissue tumor. A neuroma can develop in different parts of the foot. The thickening or enlargement of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage. Most commonly occurs in the spacing between the third and fourth toes (Morton’s neuroma) and less commonly in the spacing between first and second, second and third or fourth and fifth toes. It is sometimes referred to as an intermetatarsal neuroma. “Intermetatarsal” describes its location in the ball of the foot between the metatarsal bones. Neuromas may also occur in other locations in the foot.

Causes:

  • Mechanical compression or irritation of the nerve
  • Wearing shoes that have a narrow toe box
  • High-heeled shoes that cause the toes to be forced into the toe box
  • Bunions
  • Hammertoes
  • High arch foot (Pes Cavus)
  • Flat Feet
  • Repetitive irritation to the ball of the foot such as running or court sports
  • Direct trauma

Symptoms:

  • Tingling, burning, or numbness to the ball of the foot or to the toes
  • Sharp radiating discomfort to the tip of the toes.
  • Feeling of having a pebble in you shoe or having your sock bunched up underneath the toes
  • The pain is usually increased by walking and decreased with removal of the shoe and massaging the foot
  • Separation or splaying of the affected toes (Sullivan’s sign)

Overtime the symptoms progressively worsen and may persist for several days or weeks. The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

Treatment:

  • Padding / off-loading. This can be achieved with a metatarsal bar or a metatarsal cookie. Its goal is the lower the pressure on the nerve hence decreasing its irritation
  • Activity modification. Running on soft surfaces. Use soccer field rather than concrete surfaces
  • Shoe modification. Stiffer sole shoe places less pressure on the nerve and larger toe box does the same.
  • Inserts / orthotics
  • Icing
  • Cortisone injection.  The use of this treatment should be limited by the total number of injections given.

Surgical treatment:

Surgical intervention should be considered as the last resort. It requires the excision of the neuroma or the release of the nerve. It does present with its own risk and possible negative side affect.

We encourage you to consult with a foot and ankle specialist for a complete assessment of your condition.

Dr. Jones Hormozi at Valley Foot & Ankle Center (VFAC) utilizes state-of-the-art technology, minimally invasive procedures, and advanced techniques to prevent and treat all conditions of the foot and ankle. This allows most patients to walk immediately after most procedures, and they are able to rapidly return to high levels of functioning with excellent outcomes.