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Neuromas

A neuroma is a painful nerve that usually forms between the 3rd and 4th toes. This problem, commonly called a Morton's Neuroma, begins when the outer coating of a nerve in your foot thickens. This thickening is caused by irritation that results when two bones repeatedly rub the nerve (often due to ill-fitting shoes or abnormal bone movement). Nerve problems resulting from complications of diabetes, hammertoes and soft tissue masses may also cause neuroma-like symptoms. 

Symptoms:
Neuroma pain may start gradually, and causes burning, tingling, cramping, or numbness. Symptoms often occur after you have been walking or standing for a period of time. It may feel like you're stepping on a marble or lump. You may need to take your shoe off and rub your foot. In some cases, the pain radiates from the tip of the toes to the ankle causing you to walk differently. Some people feel like there is a "clicking" between the toes.

Tests:
 X-rays may be used to identify a possible neuroma, or to rule out other causes of pain. Ultrasound, which uses sound waves to show internal soft tissue, may also be performed. A diagnostic test, which can also relieve pain, involves blocking the nerve by injecting anesthesia around it. Generally, clinical examinations alone with a thorough history may diagnose a neuroma.

Treatment:
After your evaluation, your physician will discuss the most appropriate care for your neuroma. Some specific treatments include:
Non-surgical Treatment:

Orthotic Devices: Custom shoe inserts adjust the structural support of your foot, helping to prevent nerve irritation. Some pads may help spread the bones apart to decrease the irritation.

Ultrasound Therapy: Sound waves may help reduce swelling around the neuroma.

Medication: Cortisone injections or other medication can relieve pain and swelling in the nerve's outer coating. Sometimes a sclerosing angent may be used to destroy the nerve. This may require a few injections and cause permanent numbness.

Shoe Modifications: Pads can cushion and support the parts of your foot that are vulnerable. Roomy, supportive shoes can help prevent irritation.

Surgical Treatment:
If nonsurgical care doe not give sufficient relief, surgery may be necessary to remove or decompress the neuroma. A local anesthetic with sedation may be used for this procedure. Following surgery, you may feel numbness in the area where the nerve was removed. Your physician will tell you how soon you can be on your feet, but generally you may return to normal activities within three to six weeks.

*photo credit: The StayWell Company / Krames Patient Education