The term neuroma refers to a swelling of a nerve. The nerve most commonly affected is a small nerve that passes between the 3rd and 4th toes and is named Morton’s neuroma. Patients commonly complain of severe sharp pain in the ball of the foot that radiates to the toes.
SYMPTOMS OF A NEUROMA
- Begins with numbness or tenderness in the foot, just behind the 3rd and 4th toes
- At a later stage, pain, numbness, burning and tingling sensations can radiate around the foot.
- The symptoms may appear and disappear spontaneously.
- There maybe a sensation of a pebble in your shoe or the socks bunching up under your toes
- Severe pain may be present while standing.
- The patient may experience spontaneous shooting pains, which is often referred to as an “electric shock”. This can affect patients when are sleeping at night.
CAUSES OF A NEUROMA
- The pulling of the ligaments under the foot irritates the nerve.
- High heels can damage the nerve.
- A tight toe box will squeeze the toes in the foot and therefore put pressure on the nerve.
- Mechanical problems with the feet such as “over pronation”. Over pronation can be simply described as a condition, which causes your arches to flatten out when you stand up. This causes your ankles to roll in towards each other and disturbs your normal walking pattern. If a foot over pronates the structures of the foot are put under stress, which increases the likelihood of a neuroma occurring.
- Treatment is first to modify the shoes. A pad in the shoe and an extra-wide, soft shoe will help. A cortisone injection around the nerve may help reduce swelling and inflammation. Often orthotics are ordered to prevent the abnormal pronation and reduced the pressure on the nerve.
- Ultrasound guided, de-hydrated alcohol injection has been successfully used in our office to reduce the size and painful symptoms of the neuroma. Dr. Aslmand has performed hundreds of these procedures with seventy six percent improvement, reducing the need of surgery.
- Surgery is used as a last resort to remove the enlarged nerve. This can be done when necessary. It is successful around 95% of the times. Since a nerve is removed, there is numbness in the toes and in the ball of the foot afterward. This is not usually a problem and it becomes less so with time.