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 in 80% of cases. Other types are located between the other 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 on rare occasion occur in other locations in the foot.
The thickening, or enlargement, of the nerve is the result of its compression and irritation. It creates swelling of the nerve, eventually leading to permanent nerve damage.
Symptoms of a Morton’s Neuroma
- Tingling, burning, or numbness
- A feeling that something is inside the ball of the foot, or that there is a rise in the shoe or that the sock is bunched up.
- Cramping in the forefoot
The progression of a Morton’s neuroma often follows this pattern:
- The symptoms begin gradually. At first they occur only occasionally, when wearing narrow shoes or performing certain tight activities.
- The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.
Over time, the symptoms progressively worsen and may persist for several days, weeks or years.
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.
In developing a treatment plan, your podiatrist will first determine for how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.
For mild to moderate cases of neuroma, treatment options include:
- Icing. Apply an icepack on the affected area helps reduce swelling.
- Orthotic devices. Custom orthotic devices provided by your podiatrist 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.
- Changes in footwear. It is important to wear shoes with a wide toe box and avoid narrow shoes or high heels.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce the pain and inflammation.
- Cortisone Injection therapy.
- Perform surgery when all else fails.