What Is a Neuroma?
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 between 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. Neuromas may also occur in other locations in the foot.
The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression enlarges the nerve, eventually leading to long-term nerve damage.
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 tight toe box or high-heeled shoes that cause the toes to be squeezed into the toe box. People with certain foot deformities—bunions, hammertoes, flatfeet or more flexible feet—are also at a 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 certain sports. An injury or other type of trauma to the area may also lead to a neuroma.
In order to reach an accurate 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 and may perform other tests or imaging studies.
The best time to see your foot and ankle surgeon is early in the development of symptoms. Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may help you avoid surgery.
In developing a treatment plan, your foot and ankle surgeon will first determine how long you've had the neuroma and will evaluate its stage of development. Treatment plans depend on the severity of the problem.
For mild to moderate neuromas, treatment options may include:
Padding. Padding provides support for the metatarsal arch which lessens the pressure on the nerve and decreases the compression when walking.
Icing. Placing an icepack on the affected area can help reduce swelling.
Orthotic devices. Custom orthotics prescribed 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.
Shoe modifications. Wear shoes with a wide toe box and avoid narrow-toed shoes or high heels.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or Tylenol, may be recommended to reduce pain and inflammation.
Injection therapy. Treatment may include injections of cortisone, local anesthetics or other agents.
When Is Surgery Needed?
Surgery may be considered with patients who have not responded adequately to nonsurgical treatments. Your foot and ankle surgeon will determine the approach that is best for your condition. The length of the recovery period will vary depending on the procedure performed.
Regardless of whether you have undergone surgical or nonsurgical treatment, your surgeon will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities to reduce the repetitive pressure on the foot.