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A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton's neuroma, which occurs at the base of the third and fourth toes. It is sometimes referred to as an intermetatarsal neuroma. "Intermetatarsal" describes its location in the ball of the foot between the metatarsal bones (the bones extending from the toes to the middle 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 swelling of the nerve, eventually leading to permanent nerve damage.

Symptoms:

• Tingling, burning, or numbness
• Pain
• A feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.

What Causes a Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

People with certain foot deformities (bunions, hammertoes, flatfeet, or more flexible feet) are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma.

Diagnosis

To arrive at a diagnosis, the foot and ankle surgeon will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor attempts to reproduce your symptoms by manipulating your foot. Other tests may also be performed.

Treatment

For mild to moderate cases of neuroma, treatment options include:

• Padding: Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
• Icing: Placing an ice pack on the affected area helps reduce swelling.
• Orthotic devices: Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
• Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
• Changes in shoewear: It's important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• Injection therapy: If there is no significant improvement after initial treatment, injection therapy may be tried.

Surgery Needed?

Surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma the affected nerve is either removed or released. Your foot and ankle surgeon will determine which approach is best for your condition.

Copyright © 2005,American College of Foot and Ankle Surgeons