What is a neuroma?
A neuroma is an injury that occurs in the forefoot, between the balls of the feet (where the metatarsal bone joins to the bones of the toes). The injury typically occurs between the spaces of the 3rd and 4th metatarsophalangeal joints (commonly referred to as a Morton’s neroma); however it can also occur between any of the 2nd – 5th metatarsophalangeal joints.
The injury affects the nerve that sits in-between the metatarsal bones. Typically, it is irritation or inflammation of the nerve that then results in a thick scar tissue formation around the sheath of the nerve.
What are the symptoms of a neuroma?
Symptoms are characteristically gradual in nature. They may begin as inconsistent, brought on by certain shoes or activities. Ceasing activity or removing tight footwear often assists in early stage management to alleviate pain. Once enough scar tissue has developed around the nerve, treatment and pain may be prolonged.
Symptoms that are often associated with a neuroma include:
• A sharp ‘pinched nerve’ feeling in the forefoot and around the ball(s) of the feet
• Tingling, burning or numbness in the forefoot – sometimes referring pain to the toes
• Pins and needles around the balls of the feet or toes
Diagnosis is usually made by a combination of a physical examination and taking a thorough history. In some cases, you may be referred for a diagnostic musculoskeletal ultrasound, particularly if the diagnosis is uncertain or if there is suspicion of concurrent injuries in the forefoot.
What are some of the causes of neuromas?
Anything that causes compression, irritation or results in excessive pressure on the nerve can contribute to the development of a neuroma.
Some of these causes can be internal to the foot including:
• Toe deformities (hammer/claw toe)
• Hallux valgus (commonly referred to as ‘bunions’)
• Flat feet
• A more flexible foot type
• Gait /poor foot biomechanics
• A history of, or current plantar plate ligament injury
External causes may include:
• Poorly fitted footwear – tight and narrow toe box
• Repetitive trauma (high impact sports and activities)
• Thin and hard soled shoes
• Unsupportive footwear
• High heeled shoes
Neuroma treatment options
Treatment options for neuromas can vary depending on factors such as severity, length of injury, gait patterns (the way you walk), foot type/structure and footwear.
Treatment options vary from conservative measures to more invasive methods. In some more severe cases, although rare and usually reserved as a last resort, surgery is an option.
Common neuroma treatment options include:
• Taping/strapping techniques
• Laser and heat ultrasound
• Modification of activity
• More supportive shoes
• Steroid injections
When should I see a podiatrist for a neuroma?
Like most injuries, the earlier the treatment begins, the better. We know a neuroma begins gradually and gets worse as symptoms become more consistent and treatment is delayed.
Early intervention helps to prevent the injury from worsening and can result in a quicker recovery time. Should the symptoms linger and become increasingly present or chronic, it can be more difficult and time consuming to resolve.
If you feel any sharp forefoot pains, tingling, numbness or pins and needles around your forefoot, it is important to have your feet assessed by one of our Melbourne Podiatrists as soon as possible.