What is a Neuroma? - WVVA TV Bluefield Beckley WV News, Weather and Sports

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot and is called Morton's neuroma. This lesion commonly 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 (the bones extending from the toes to the midfoot).

Neuromas may also occur in other locations in the foot.       

The thickening, or enlargement, of the nerve defining 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.

What are the symptoms of a Morton's neuroma?

If you have a Morton's neuroma, you will probably have one or more of these symptoms where the nerve damage in occurring:

1. Tingling, burning, or numbness
2. Pain
3. A feeling that something is inside the ball of the foot, or that there's a bump in the shoe or a feeling you're your sock is bunched up.  

The progression of Morton's neuroma symptoms often follows this pattern:

1. The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.
2. The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
3. Over time, the symptoms progressively worsen and may persist for several days or weeks.

The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

Treatment for neuroma.   In developing a treatment plan, I will first determine how long you've had the neuroma-type symptoms and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.

It has been my experience in 44 years of practice that this is the most over diagnosed foot malady. In the years that I have been in practice I have found no more then 10 true neuromas. The majority of the "neuromas" are due to either muscle spasm that is pinching the nerve, neuropraxia or joint pain that is mimicking nerve type pain. Other considerations are neuropathies due to anemia, sciatica and diabetes.

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

1. Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
2. Orthotic devices. Custom orthotic devices provide your foot and ankle the support needed to reduce pressure and compression on the nerve or soft tissue.
3. Activity modifications. Activities that put repetitive pressure on the ball of your foot, such as climbing ladders, walking on concrete, certain exercises that include stooping and bending, should be avoided until the condition improves.
4. Changes in shoe wear. It's important to wear shoes that are appropriate for your foot size and body type.  You should avoid wearing tight thin-soled shoes or flat shoes if you have a high arch. High heel shoes are NOT a deterrent.
5. Anti-inflammatory medications. These help control pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available. Once again, this is an over-simplification of essential medical science. Be aware that Non-Steroidal Anti-Inflammatory Drugs, known as NSAID's, cause more trips to the ER then any other medications.
6. Physical Therapy Cold Laser along with Electro-acupuncture has proven to be an excellent and non-painful approach to neuralgic type pain.
7. Injection therapy. If there is no significant improvement after initial treatment, injection therapy should be tried. With new injectable techniques, the procedure is relatively painless and affords immediate relief. Sometimes only one injection is needed but generally 2-3 is sufficient.
8. Radiofrequency Therapy. Newer therapies that do not entail the use of radical surgery are always becoming more accepted. The latest one to appear that has been used frequently in spinal nerves is high-energy radiofrequency. It is relatively painless and effective. We use it to successfully treat heel pain caused by a pinched nerve along with neuroma-type foot pain. It is an in-office procedure and does not require any down time.

When is surgery needed?   Surgery may be considered if you have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma. These are both hospital procedures that either remove or release the affected nerve. I will determine which approach is best for your condition.

The length of the recovery period will vary, depending on the procedure or procedures performed. Regardless of whether you've undergone surgical or nonsurgical treatment, I will recommend conservative and common sense measures to help keep your pain from returning. These include appropriate footwear and modification of activities that can cause repetitive injury to your foot.