Neuromas

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. Neuromas may also occur in other locations in 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. 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.

Typically, there's no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms:

• A burning pain in the ball of your foot that may radiate into your toes
• Tingling or numbness in your toes

At first, the pain may worsen when you wear tight or narrow shoes or engage in activities that place pressure on your foot. Over time, though, symptoms may last for days or weeks.

Treatment approaches vary according to the severity of the problem. For mild to moderate cases of neuroma, treatment options include:

• Massage.  Dr. Prant can show patients a specific massage aimed at reducing symptoms.
• Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.  Neuroma pads are precisely placed  to separate and spread the metatarsals. 
• Icing. Placing an icepack on the affected area helps reduce swelling.
• Orthotic devices. Custom orthotic devices provided by Dr. Prant provide the support needed to reduce pressure and compression on the nerve.   Arbor Foot Health Center carries orthotic devices in all price ranges. 
• Activity modifications. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.  Specific recommendations will be made by Dr. Prant after careful examination. 
• 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. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
• Injection therapy. Ultrasound guided steroid injections can help reduce pain and inflammation when NSAIDs are ineffective.  We find that ultrasound guided injections are particularly effective because it places the medication exactly where it is needed to reduce the inflammation.

With proper therapy, surgery is almost never needed!

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