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Neuroma

The Condition

A neuroma is typically a benign thickening of the nerve that develops along the plantar surface near the ball of the foot. It will most commonly affect the space between the second and third or third and fourth metatarsals. The thickening is usually as a result of compression and irritation of the nerve causing enlargement and even permanent damage to the nerve. Most people will develop pain, tingling or burning, or even the sensation that your sock is all wadded up in the shoe.

The Treatment

Before treatment can begin, your podiatrist will perform a thorough history and physical examination, and likely order X-rays and possibly advanced imaging studies such as an ultrasound or MRI to confirm this diagnosis. Advanced imaging is often necessary as the metatarsophalangeal joint capsule just adjacent to the neuroma on either side can also be inflamed (capsulitis) and cause similar symptoms. Treatment for this problem is divided into two categories: surgical and non-surgical.

Non-surgically, your podiatrist can recommend icing, adding padding to your shoes, activity or shoe gear modifications, custom orthotics and possibly oral medication for inflammation. An additional non-surgical treatment that will likely be offered is injection therapy. The injection will likely consist of a local anesthetic as well as a steroid. Surgically your podiatrist would suggest excision of the neuroma if other treatment options have failed.

Frequently Asked Questions

Yes. Any shoe that causes additional pressure to the nerve can lead to inflammation and damage of the nerve.

The injection usually takes about 15-20 seconds to administer. Most commonly people feel better as they are leaving the office. A very small percentage of patients may experience a flare reaction or pain at the injection site for a day or two after the injection. This is easily treated with ice and oral over-the-counter medication such as ibuprofen or acetaminophen.

The adjacent portions of the affected toes will be numb after surgery because the nerve that supplies sensation to these areas will be removed surgically.

Very rarely can the neuroma return after it is removed surgically, but it is possible. To determine if the neuroma has recurred your surgeon will repeat their physical examination and advanced imaging will be ordered.

Neuromas in the plantar forefoot are more typically a response to a compressive or irritating force to the nerve. However, certain foot structures can have a higher predilection to the development of a neuroma because of the pressure that is placed on the forefoot with weight bearing and ambulation.