Description

Neuromas are the swelling of nerves that are the result of 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 the ball of the foot. The most common cause of a neuroma in the ball of the foot, is the abnormal movement of the long bones behind the toes called metatarsals. 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 that 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.

A 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.

Diagnosis

The diagnosis of neuroma 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, and inflammation or arthritis of the joint between the metatarsal bone and the toe. Because nerve tissue is not seen on an x-ray, the x-ray will not show the neuroma. A skilled foot specialist may be able to actually feel the neuroma on the exam of the foot. If the doctor cannot feel the neuroma, an MRI may be recommended to confirm the diagnosis of a neuroma.

Treatment

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 it 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.

To address the abnormal movement of the metatarsal bones, functional foot orthotics 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 there is significant damage to the nerve, failure of 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 of the nerve.

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