Neuromas

A neuroma, or “pinched nerve” or nerve tumor, is a painful condition that begins with benign growth of nerve tissue most commonly felt between the third and fourth toes but can also occur in the area between the second and third toes.

The symptoms seem to be caused by irritation of the nerve that runs in the space between each toe. The pain feels like a burning sensation, tingling, or numbness between the toes and in the ball of the foot.

Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe.

The nerves of the foot run into the forefoot and out to the toes between the long metatarsal bones of the feet. Each nerve splits at the end of the metatarsal bone and continues out to the end of the toe. Each nerve ending supplies feeling to two different toes. The neuroma occurs in the nerve just before it divides into the two branches, the area under the ball of the foot. A neuroma is formed by the swelling or thickening in this part of the nerve.

Causes of Neuromas

A number of factors can contribute to the formation of a neuroma even though it is not entirely understood why neuroma forms. It is likely the result from repeated injury to the nerve in this area.

The most common cause of pain is thought to be irritation on the nerve. The chronic nerve irritation is believed to cause the nerve to scar and thicken, creating the neuroma. Many foot surgeons feel that the problem may arise because the metatarsal bones squeeze in on the nerve, and the ligament that joins the two bones irritates, or entraps, the nerve. Entrapment of the nerve is thought to lead to the chronic irritation and pain.

Biomechanical deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition.

Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve.

Improper footwear that causes the toes to be squeezed together is problematic. Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.

Repeated stress, common to many occupations, can create or aggravate a neuroma.

Symptoms of Neuromas

The neuroma usually causes pain in the ball of the foot when weight is placed on the foot. Many people with this condition report feeling a painful catching sensation while walking, and many report sharp pains that radiate out to the two toes where the nerve ends. You may feel swelling between the toes or a sensation similar to having a rock in your shoe. This can feel like electric shocks, similar to hitting the funny bone on your elbow.

•  Pain in the forefoot and between the toes.
• Tingling and numbness in the ball of the foot.
• Swelling between the toes.
• Pain in the ball of the foot when weight is placed on it.

Diagnosis of Neuromas

The diagnosis is usually made on history and physical examination alone. X-rays are only useful to make sure the pain is not coming from something else.

Treatment of Neuromas

The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops.

What Can You Do for Relief?

• Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.
• Wear shoes with thick, shock-absorbent soles and proper insoles that are designed to keep excessive pressure off of the foot.
• High heels should be avoided whenever possible because they place undue strain on the forefoot and can contribute to a number of foot problems.
• Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort.
• For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, podiatric medical treatment or surgery may be necessary to remove the tumor.
• Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.

Nonsurgical Treatment

Treatment of a neuroma usually begins with changes in shoe wear. Sometimes simply moving to a wider shoe will reduce or eliminate the symptoms. A firm, crepe-soled shoe may help. The firm sole decreases the amount of stretch in the forefoot as you take a step. This lessens the degree of irritation on the nerve.

Also, an injection of lidocaine and cortisone into the area may help temporarily relieve symptoms. This is usually short-lived (days to weeks) and is mainly useful to help the doctor make a diagnosis.

Orthotic Devices

Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the condition.

Surgery

If these nonsurgical measures fail to resolve the pain, surgery may be suggested. There are several different approaches to treating the neuroma surgically. Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical correction.

Neuroma Removal

The more traditional procedure involves removing the neuroma. Since the neuroma is part of the nerve, the nerve is removed, or transected, as well. This results in permanent numbness in the area supplied by the nerve.

To remove a neuroma surgically, a small incision is made in the skin between the two toes that are affected by the neuroma. The neuroma is located and removed by cutting the nerve. The skin incision is repaired with stitches and a dressing applied.

Ligament Release

Many foot surgeons believe that removing the nerve as the initial surgery may be too radical. These surgeons suggest that a simple operation to release the ligament between the metatarsal bones will reduce the squeezing action by the metatarsals and remove the irritation on the nerve by the ligament. If this surgery fails, the more traditional approach to removing the nerve can be done later. One of the benefits to this procedure is that you are not left with any numbness in the toes.