A neuroma in the foot is a painful condition affecting the ball of the foot which is caused by a normal nerve becoming swollen. This condition can lead to symptoms, such as pain in the ball of the foot and/or toes characterized by a sharp or burning or tingling sensation or sometimes even numbness. Some patients complain of a feeling of a pebble in their shoe or that their sock has been bunched up inside the shoe.
Causes of Neuroma consist of shoe type, specific activity, and/or foot deformity or condition.
- Shoes - any shoe with a tight or narrowed toe box can be a source of this condition. Also, shoes that have a higher heel will cause increase pressure through the fore foot which also can be a contributing factor. Also, shoes that have a very weak or flexible soul can end up causing increased pressure through the forefoot.
- Activity - certain types of activity can predispose you to the prevalence of this condition. For example, any sport that puts extra or excessive force through the forefoot, such as tennis or pickle ball, dancing, or rock climbing. Also, certain sports or exercise that necessitate the need for a specific shoe can contribute to the prevalence of this condition. For instance, biking or cycling requires a specific shoe type that in some cases has a narrowed and rigid toe box.
- Foot deformity or condition -certain conditions of the foot can predispose you to having a neuroma. For example, any condition that limits normal function of the big toe joint will cause compensation to the lesser metatarsal area, which will inadvertently put added pressure through the nerves in that area of the foot. Hallux limitus is a condition that causes a restricted or limited motion of the big toe joint. A normal compensation for this condition is to divert pressure laterally to the lesser metatarsal area which again can cause increase pressure through the nerves of the forefoot.
How to Diagnose a Neuroma
The main way to diagnose a neuroma is clinically in the exam room with your doctor or podiatrist. Typically, pain is reproduced with plantar pressure through the forefoot sometimes creating a clicking sensation where the nerve is swollen. Many times, regular foot x-rays will be used to rule out other conditions, such as stress fractures. Ultrasound can be effective at helping to diagnose neuromas as well as MRI.
Treatment
The first line of treatment is to try to address a potential cause. For instance, removing a certain activity or shoe type that may be a contributing factor. Moving forward, treatment consist of wearing good supportive shoes that have adequate room in the toe box and a lower heel height. Arch supports or orthotics can also be helpful. An arch support can help to distribute pressure thereby reducing pressure in the area of the swollen nerve. Metatarsal pads can be added to the arch support to also help divert pressure away from the swollen nerve. Daily icing can help reduce inflammation and rest is also very important. If pain persist beyond these first steps sometimes non-steroidal anti-inflammatories are prescribed or Cortisone injections are delivered to the area around the inflamed nerve. For the very resistant neuroma surgical excision tends to be very effective.
Conclusion
Just like with most medical conditions, neuromas are best treated with early detection. Starting treatment during the early stages has a higher success of resolving the problem. Please remember to consult your podiatrist if you suspect neuroma.
Written by
Dr. Jeffrey S. Hurless
DPM, FACFAS Board Certified Foot & Ankle Surgeon/Podiatrist
Medical Director, HealthyFeetStore.com