A neuroma is a thickening of nerve tissue generally caused by compression, irritation, or trauma to a nerve. Problematic neuromas are often described as a tingling, burning or numb sensation which can be painful. Patients commonly report the sensation of something being stuck to the ball of the foot, or the sensation of bunched up sock.

The most common site of neuroma formation in the foot is between the third and fourth toes where two nerves join together creating a thicker nerve which is more susceptible to impingement and compression between the metatarsal bones on both sides, the deep transvers intermetatarsal ligament from above, and the ground from below. Morton’s neuroma refers specifically to a neuroma between the third and fourth toes. Intermetatarsal neuromas can occur between the other toes as well.  Narrow shoes and shoes with an elevated heel can make this worse.

Treatment:
Wide shoes, or shoes with an anatomic foot shape, where they are wider and boxier in the forefoot are recommended. Shoes with a lower heel are also helpful. Shoe inserts and custom orthotics can also help with mechanical decompression of the nerve. Metatarsal pads / bars can be helpful with mechanical decompression of the nerve if they are correctly positioned. If they are not properly positioned, they can increase pain and symptoms. Metatarsal pads / bars work best when they are incorporated into a custom orthotic prescription.

Rest, ice, and pain medication such as NSAIDs or acetaminophen can also be helpful in managing pain. Steroid injections can be helpful when pain is significant. Serial cortisone injections can also help decrease inflammation to the nerve and associated inflammatory thickening of the nerve.

Surgical correction, such as a neuroma decompression or excision (neurectomy) can be helpful if conservative care does not provide adequate relief.

If you are having significant pain and discomfort, your symptoms are limiting physical activity, or affecting your quality of life, schedule an appointment now for an evaluation and discussion of your feet and treatment options.