A neuroma is the swelling of nerve that is a
result of a compression or trauma. They are often described as nerve
tumors. However, they are not in the purest sense a tumor. They are a
swelling within the nerve that may result in permanent nerve damage.
The most common site for a neuroma is on the ball of the foot. The most
common cause of neuroma in ball of the foot is the abnormal movement of
the long bones behind the toes called metatarsal bones. A small nerve
passes between the spaces of the metatarsals. At the base of the toes,
the nerves split forming a "Y" and enter the toes. It is in this area
the nerve gets pinched and swells, forming the neuroma. Burning pain,
tingling, and numbness in one or two of the toes is a common symptom.
Sometimes this pain can become so severe, it can bring tears to a
patient's eyes. Removing the shoe and rubbing the ball of the foot
helps to ease the pain. As the nerve swells, it can be felt as a
popping sensation when walking. Pain is intermittent and is aggravated
by anything that results in further pinching of the nerve. When the
neuroma is present in the space between the third and fourth toes, it
is called a Morton's Neuroma. This is the most common area for a
neuroma to form. Another common area is between the second and third
toes. Neuromas can occur in one or both of these areas and in one or
both feet at the same time. Neuromas are very rare in the spaces
between the big toe and second toe, and between the fourth and fifth
toes. Neuromas have been identified in the heel area, resulting in heel pain.
puncture wound or laceration that injures a nerve can cause a neuroma.
These are called traumatic Neuromas. Neuromas can also result following
a surgery that may result in the cutting of a nerve.
The diagnosis of Neuromas is made by a physical exam and a thorough
history of the patient's complaint. Conditions that mimic the pain
associated with Neuromas are stress fracture of the metatarsals,
inflammation of the tendons in the bottom of the toes, arthritis of the
joint between the metatarsal bone and the toe, or nerve compression or
nerve damage further up in the foot, ankle, knee, hip, or back. X-rays
are generally taken to rule out a possible stress fracture or
arthritis. Because nerve tissue is not seen on an x-ray, the x-ray will
not show the neuroma. A skilled foot specialist will be able to
actually feel the neuroma on his exam of the foot. Special studies such
as MRI, CT Scan, and nerve conduction studies
have little value in the diagnosis of a neuroma. Additionally, these
studies can be very expensive and generally the results do not alter
the doctor's treatment plan. If the doctor on his exam cannot feel the
neuroma, and if the patient's symptoms are not what is commonly seen,
then nerve compression at another level should be suspected. In this
instance, one area to be examined is the ankle.
below the ankle bone on the inside of the ankle, a large nerve passes
into the foot. At this level, the nerve can become inflamed. This
condition is called Tarsal Tunnel Syndrome.
Generally, there is not pain at this site of the inflamed nerve at the
inside of the ankle. Pain may instead be experienced in the bottom of
the foot or in the toes. This can be a difficult diagnosis to make in
certain circumstances. Neuromas, however, occur more commonly than
Tarsal Tunnel Syndrome.
Treatment for the neuroma consists of cortisone injections, orthotics, chemical destruction of the nerve, or surgery.
Cortisone injections are generally used as an initial form of
treatment. Cortisone is useful when injected around the nerve, because
is can shrink the swelling of the nerve. This relieves the pressure on
the nerve. Cortisone may provide relief for many months, but is often
not a cure for the condition. The abnormal movements of the metatarsal
bones continue to aggravate the condition over a period of time.
address the abnormal movement of the metatarsal bones, a functional
foot orthotic can be used. These devices are custom-made inserts for
the shoes that correct abnormal function of the foot. The combination
treatment of cortisone injections and orthotics can be a very
successful form of treatment. If, however, there is significant damage
to the nerve, then failure to this treatment can occur. When there is
permanent nerve damage, the patient is left with three choices: live
with the pain, chemical destruction of the nerve, or surgical removal or decompression of the nerve (see neuroma surgery).
Back to Top