A Neuroma is a pinched nerve which causes pain.
A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumour. It is a benign growth of nerve tissue frequently found between the third and fourth toes metatarsal heads. It is not a “true” Neuroma in the sense that it does not involve a general cellular change with the effected nerve but rather a fibrous type sheath that surrounds the nerve.
The nerve that is commonly affected is the third communicating branch of the medial and lateral plantar nerve of the fore-foot. This nerve supplies the 3rd and 4th toes and their intervening web space and when this nerve is affected we name the Neuroma a “Morton’s Neuroma” .
If the Neuroma affect the 2nd or Big toe, we call it a Joplin’s Neuroma, if it affects the 4th or 5th toes we can it a Hick’s Neuroma.
In general terms it is also appropriate to call all of them Traumatic Inter-Metatarsal Neuromas as they are all caused by Mechanical Trauma and they all tend to originate from, or under, the inter-metatarsal spaces.
Neuromas can cause pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.
The principal symptom associated with a neuroma is pain between the toes while walking. 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 vast majority of people who develop neuromas are women.
Other symptoms of a neuroma include:
- feeling that you are "walking on a marble,"
- 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
- Irritation and pain particularly in high-heeled shoes
- Irritation and pain particularly in tight, narrow shoes, compressing the toe bones and pinching the nerve.
Although the exact cause for this condition is unclear, at a cellular level we understand that this nerve sheath thickening is a direct physiological response to abnormal compression and shear stress than push onto the nerve from the surrounding metatarsal heads, that for various reasons, squeeze against it.
A number of factors can contribute to the formation of a neuroma:
- 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 and increased point loading 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 6cm. Shoes at this height can increase pressure on the forefoot area.
- Repeated stress, common to many occupations, can create or aggravate a neuroma.
- Tightness in the calf muscle resulting in increased fore-foot pressure during weight-bearing
- Change in occupation, moving form a sedentary to active or vice versa can produce an increase in weight bearing activity or change in footwear
- Pregnancy, increase body weight, increased forefoot joint instability due to general normal related ligamental laxity
Mr Edwards will examine and likely utilise ultrasonic investigation or may refer for a MRI investigation of the affected area and suggest a treatment plan that best suits your individual case.
Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical correction.
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, additional treatment or surgery may be necessary to remove the tumour.
Padding and Taping: Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma.
Medication: Anti-inflammatory drugs and cortisone injections can be used to ease acute pain and inflammation caused by the neuroma however, may not offer a long-term relief.
Orthotics: Prescription orthotics may be useful in controlling foot function and may reduce symptoms and prevent the worsening of the condition.
Surgical Options: When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve.
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. The skin incision is the closed with sutures and a dressing applied.
You may require crutches for a few days after surgery. The foot will remain tender for several days. The incision is protected with a bandage or dressing for about one week after surgery. The sutures are generally removed in 10 to 14 days. However, Mr Edwards often utilises sutures that dissolve; you won't need to have these taken out.
Ligament Release (or Inter-Metatarsal Decompression
In certain cases Mr Edwards may suggest that a simple operation to release the ligament between the metatarsal bones is all that it required. This 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.
These surgical procedures can be done with a type of local anaesthesia. Only your foot goes to sleep. The surgery is most commonly done as a day stay procedure and is performed utilising a minimal incision requiring one to two sutures. Again the sutures are generally removed in 10 to 14 days. However, Mr Edwards often utilises sutures that dissolve, you won't need to have these taken out.
You will not require crutches and should experience minimal post-operative discomfort. You will be able to return to normal activity one to two days after surgery.
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, as well as proper insoles that are designed to keep excessive pressure off of the foot.
- High-heeled shoes over 6cm tall should be avoided whenever possible because they place undue strain on the forefoot.
- 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.
- Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.
Although the exact causes of neuromas are not completely known, the following preventive steps may help:
- Make sure your exercise shoes have enough room in the front part of the shoe and that your toes are not excessively compressed.
- Wear shoes with adequate padding in the ball of the foot.
- Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than 6cm).
For further advice or to make an appointment, please contact one of our professional team, our numbers and contact details are listed on the Contact page.