What is Neuroma?

Do you consistently feel a tingling in your toes or feet, or often feel like there’s a bunched-up sock in your shoes no matter how many times you adjust them? You might be experiencing symptoms of a neuroma. Rachel Perl, DPM, a Podiatrist at Crystal Run Healthcare, explains what may be causing those uncomfortable symptoms and how to best treat them.

What Is a Neuroma?

A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage.

The most common neuroma in the foot is a Morton’s neuroma. A Morton’s neuroma usually occurs between the third and fourth toes, but may also occur in other locations in the foot.

Causes

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot deformities—bunions, hammertoes, flatfeet, or more flexible feet—are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury or other type of trauma to the area may also lead to a neuroma.

Symptoms

If you have a Morton’s neuroma, you may have one or more of these symptoms where the nerve damage is occurring:

• Tingling, burning, or numbness
• Pain
• A feeling that something is inside the ball of the foot
• A feeling that there is something in the shoe or a sock is bunched up

The progression of a Morton’s neuroma often follows a pattern:

• The symptoms begin gradually. At first, they occur only occasionally when wearing narrow-toed shoes or performing certain aggravating activities.
• The symptoms may go away temporarily by removing the shoe, massaging the foot, or avoiding aggravating shoes or activities.
• Over time, the symptoms progressively worsen and may persist for several days or weeks.
• The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

Diagnosis

A podiatrist will obtain a thorough history of your symptoms and examine your foot. During the physical examination, your podiatrist will attempt to reproduce your symptoms by manipulating your foot. Other tests or imaging studies may also be performed.

The best time to see a podiatrist is early in the development of symptoms. Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may help you avoid surgery.

Nonsurgical Treatment

In developing a treatment plan, your podiatrist will first determine how long you have had the neuroma and will evaluate its stage of development. Treatment approaches vary according to the severity of the problem.

For mild to moderate neuromas, treatment options may include:

• Padding: Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
• Icing: Placing an icepack on the affected area helps reduce swelling.
• Orthotic devices: Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
• Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
• Shoe modifications: Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
• Medications: Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
• Injection therapy: Treatment may include injections of cortisone, local anesthetics, or other agents.

When Is Surgery Needed?

Surgery may be considered in patients who have not responded adequately to nonsurgical treatments. Your podiatrist will determine the approach that is best for your condition. The length of the recovery period will vary depending on the procedure performed.

Regardless of whether you have undergone surgical or nonsurgical treatment, your provider will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities to reduce the repetitive pressure on the foot.

Rachel Perl, DPM is a Podiatrist at Crystal Run Healthcare. She received her Bachelor of Arts in Biology & Psychology at St. John's University in Jamaica, NY, and her Doctor of Podiatric Medicine at New York College of Podiatric Medicine in New York, NY. Dr. Perl completed her Residency in Podiatric Medicine at North Shore - Long Island Jewish Medical Center in Manhasset, NY. Dr. Perl’s clinical interests include biomechanical and pediatric patients. Dr. Perl is currently seeing patients in Middletown, Newburgh, and Rock Hill.