A neuroma is the swelling of a nerve due to trauma or compression.
The most common site for neuroma is the ball of the foot and is usually caused by stress and abnormal movement of the long bones behind the toes, (the metatarsal bones). A puncture wound or laceration that injures one of the nerves can also cause a neuroma. A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a “Y” and enters the toes. It is in this area the nerve gets pinched and swells, forming the neuroma.
• Burning sensations, intermittent sharp, dull or throbbing pain, usually in the ball of the foot. Taking off the shoe and rubbing the ball of the foot usually helps to relieve the pain.
• When the neuroma is present in the space between the third and fourth toes, it is called a Morton’s Neuroma. This is the most common area for a neuroma to form.
Your podiatrist will be able to diagnose the neuroma by carrying out a physical examination or bio-mechanical assessment. X-rays are generally taken to rule out a possible stress fracture or arthritis. A skilled podiatrist may be able to actually feel the neuroma whilst examining your feet.
Conservative treatment as the first step
Conservative (non-surgical) treatment is usually the first step. If it fails, then surgical procedures will be considered. The primary aim of the treatment is to relieve the mechanical stress from the metatarsal heads where the neuroma develops.
Treatment can involve cortisone or collagen injections, or chemical destruction of the nerve.
Cortisone injections are often used as an initial form of treatment and may be useful when injected around the nerve, causing shrinkage of the swelling, which relieves the pressure. This may provide relief for many months, but is often not a cure. The abnormal movements of the metatarsal bones will continue to aggravate the condition over a period of time, so we ask our patients to get some cushion-sole shoes with a wide toe box, which is often adequate treatment to mitigate the
symptoms. Moreover, the use of foot orthosis should be considered in the vast majority of cases. Special padding at the ball of the foot may change the abnormal feet mechanics and relieve the symptoms caused by the neuroma
However, for severe conditions and when the conservative treatment fails, surgery will be considered.
Home treatment What can you do for relief?
• Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment. • Wear shoes with thick, shock-absorbent soles, as well as proper foot orthosis that are designed to relieve the pressure from the foot. • High-heeled shoes over two inches tall should be avoided • Rest the foot and massage the affected area • Use over-the-counter shoe pads. Padding can relieve pressure around the affected area
• Make sure your trainers or sport shoes have enough room in the front part of the shoe and that your toes are not excessively compressed. • Wear shoes with an adequate cushioning sole in the ball of the foot. • Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).
We recommend that people experiencing this condition, should have a biomechanical examination at least once a year. At Randell’s Footcare we have a fantastic biomechanics podiatry team who strongly believe in prevention as the best way to keep our bodies and feet in great condition. You should visit a podiatrist at the first sign of pain or discomfort. If left untreated, neuromas tend to get worse.
biomechanics, feet, pain, shoes Iván Maestre, HCPC registered podiatrist at Randell’s Footcare