Neuromas cause pain in the forefoot, typically in the area of the 3rd and 4th toes. The nature of the pain may present itself shooting, burning, stabbing or radiating in this area. One of the classic findings is relief of symptoms by removing shoes and massaging the area.
What Is a Neuroma?
The neuroma is a fibrous thickening of the nerve in the inner space between toe joints.
What Causes a Neuroma?
The exact cause of neuromas is unclear. However, it is thought that the head of the bones creating the toe joints on either side of the nerve pinch the nerve, causing inflammation and thickening. Known contributing factors are tight shoes, especially slip-on shoes, high-heeled shoes and biomechanical dysfunction such as flat feet. Also, injury or foot sprains may cause a neuroma.
General Neuroma Information:
- Occurs in all adult age groups
- More common in females
- Usually affects only one foot but may affect both
- Usually affects the nerve behind the 3rd and 4th toes
How Do I Know If I Have a Neuroma?
- Clinical examination by a physician (usually feels for a palpable click between the metatarsal heads)
- Diagnostic local anesthetic injection—mandatory prior to surgery
- X-ray of the foot to rule out other foot pathologies
When Should I Start Treating My Neuroma?
Neuromas should be treated if they are painful, limit activities or limit the shoes you can wear comfortably.
What Will Happen If I Don't Have My Neuroma Treated?
It is difficult to predict the sequelae and rate of progression of an untreated neuroma. Usually if a neuroma is untreated, the following occurs:
- Growth of the neuroma
- Increased discomfort in the area
- Inability to wear certain shoes
- Inability to perform some job duties
- Need for surgical removal
Conservative Treatment of Neuromas
Usually, conservative therapy is attempted prior to surgical intervention. Conservative options for treating neuromas include the following:
- Lace-up shoes that fit properly and have a wide toebox
- Orthotics or over-the-counter arch supports
- Injections of local anesthetic and/or corticosteroids
- Physical therapy
Conservative treatment generally has a 50% chance of relieving neuroma symptoms. See your podiatrist as soon as possible after symptoms begin—early conservative treatment improves your chances of avoiding surgery.
When Is Surgery Indicated?
When conservative therapy has failed to provide adequate relief of neuroma symptoms or conservative treatment options are impractical.
What Is Involved In Neuroma Surgery?
Surgery is usually performed under local anesthesia with IV sedation. After surgery you will have to keep your foot dry for two weeks. Generally neuroma surgery allows for early weight-bearing and protection in some type of post-op shoe gear for three to four weeks. The severe nerve pain is relieved almost immediately after surgery. Some neuromas may reoccur, but this is rare.