Patients are complaining of pain on the bottoms of their feet radiating into the toes. This pain is often the result of nerve compression or trauma. Current shoe fashions have increased the occurrence of this complaint which is commonly diagnosed as a neuroma. A neuroma is a swelling within the nerve and most often occurs between the third and fourth toes but is also seen between the second and third toes. A small nerve passes between the spaces of the long bones connecting the toes to the foot. These are the metatarsal bones. At the bases of the toes, the nerves split forming a “Y” and then the nerve enters the toes. It is in this area that the nerve gets pinched and swells, forming the neuroma.
Common symptoms of a neuroma are burning pain, tingling, and numbness in one or two toes. Sometimes the pain can become so severe, it brings tears to the patient’s eyes. Removing shoes and rubbing the ball of the foot sometimes helps to ease the pain which can be aggravated by further pinching of the nerve, compressing the forefoot in a tight shoe or traumatizing the forefoot in a shoe with an extremely high heel. It is not uncommon to see a widening of the space between the affected toes develop as the neuroma increases in size.
The pain causing a neuroma can be mimicked by pain from stress fractures of the metatarsals, inflammation of the tendons in the bottom of the foot, arthritis of the joint between the metatarsal bone and the toe, or nerve compression or nerve damage further up on the foot, ankle, knee, hip or back. Since nerve tissue is not seen on an x-ray, the x-ray will not show the neuroma but can shoe the widening of the bones that can be the result of the nerve growth. A skilled foot specialist will be able to actually feel the neuroma on examination of the foot. The podiatrist can often make the neuroma pop by moving it between the metatarsal bones and this can duplicate the patient’s pain.
Treatment for the neuroma consists of cortisone injections, orthotics, chemical destruction of the nerve or surgery. Injections are generally used as an initial form of treatment because this can shrink the swelling of the nerve and thereby relieves the pressure on the nerve. Patients often experience several months of relief following injection therapy. If abnormal movements of the metatarsal bones aggravate the condition, a custom-made foot orthotics can be helpful. If these conservative modalities do not effect significant relief, the choices are chemical destruction of the nerve or surgical removal of the nerve tumor. At Livingston Foot Care Specialists, we like to attempt conservative care for our patients. Surgical intervention is only considered if the neuroma is resistant and fails to respond .