Neuroma is usually characterised by experiencing a sharp, stabbing pain that feels better when you stop walking and massage your foot. Neuroma’s are benign and usually treatable.
A neuroma is an enlargement or thickening of a nerve in the foot in the area between the toes, usually the second or third interspace of the toes. Neuromas rarely affect the fourth and first interspaces.
Neuroma’s may also be eferred to as an intermetatarsal neuroma, interdigital neuroma, Morton’s neuroma/metatarsalgia (pain in the metatarsal area), perineural fibrosis (scar tissue around a nerve) or entrapment neuropathy (abnormal nerve due to compression).
Neuromas occur most commonly in women who are between 30 to 50 years old.
Current research and theory suggest that a neuroma is caued by an injury to the nerve. The injury may be caused by damage to the metatarsal heads, the deep transverse intermetatarsal ligament (holds the metatarsal heads together) or an intermetatarsal bursa (fluid-filled sac). All of these structures can cause compression and injury to the nerve, initially causing swelling and damage in the nerve. Over time, if the compression/injury continues, the nerve repairs itself with very fibrous tissue that leads to enlargement and thickening of the nerve.
Other common causes of injury to the nerve may include simply having an incorrect walking style or an awkward foot structure, such as overpronation (foot rolls inward), hypermobility (too much motion), pes cavus (high arch foot) and excessie dorsiflexion (toes bend upward) of the toes.
These biomechanical factors may cause injury to the nerve with every step. If the nerve becomes irritated and enlarged, then it takes up more space and gets even more compressed and irritated.
Signs & Symptoms of Neuroma
- Pain (sharp, stabbing, throbbing, shooting)
- Tingling or “pins & needles”
- A feeling that you are stepping on something or that something is in your shoe
- Initially these symptoms may occur intermittently. As the condition progresses, the symptoms may occur more regularly.
Your Podiatrist Brisbane is trained in the diagnosis and management of Neuroma and a range of forefoot symptoms. Once a diagnosis is made, evidence-based treatment options can be discussed.
- Appropriate footwear- wide and deep in the toe box so they do not put pressure on your toes and metatarsals. Avoid wearing high heels- they cause increased pressure on the forefoot
- Metatarsal padding: Designed to lift and separate the metatarsal heads to offload the nerve
- Activity modification: Swimming instead of running until symptoms subside
- Strapping and taping
- Anti-inflammatory medications- Aspirin, ibuprofen, voltaren
- Kinetic Orthotic Therapy: Aimed at permanently altering gait and pressure on the nerve
- Cortisone injection: Helps to decrease the size of the irritated, enlarged nerve.
- Alcohol injection: Helps to destroy the nerve chemically.
- Surgery: Last resort. Surgery may involve cutting out the nerve or cutting the intermetatarsal ligament. Studies have shown surgery has an 80-85% success rate. No guarantee neuroma won’t come back
If you experience painful forefoot symptoms don’t hesitate to see Podiatrist Brisbane for expert diagnosis and treatment of this condition.