Neuroma

Neuromas usually cause pain in the forefoot, especially in the area of the 3rd and 4th toes. The nature of the pain may be shooting, burning, stabbing, radiating and/or just an odd feeling in the area. One of the classic findings is relief of symptoms with removal of shoe and massaging the area.

What Is A Neuroma?
The classic Morton’s neuroma is a fibrous thickening of the nerve in the area of the 3rd and 4th toes.

What Causes A Neuroma?
The exact cause is unclear. However, it is thought the bones, metatarsals, on either side of the nerve pinch the nerve causing inflammation and thickening. Known contributing factors are tight shoes, especially slip on shoes, and biomechanical dysfunction such as flat feet. Also, injury or foot sprains may cause a neuroma.

General Neuroma Information:

• Occurs in all adult age groups
• Usually affects only one foot but may affect both
• Usually affects the nerve behind the 3rd and 4th toes

How Do I Know If I Have A Neuroma?

• Clinical examination by a physician (usually feels for a palpable click between the metatarsal heads).
• Diagnostic local anesthetic injections can be used to localize the location of the neuroma.
• X-ray of the foot to rule out other foot pathologies.

When Should I Start Treating My Neuroma?
Neuromas should be treated if they are painful, limiting activities or limiting the shoes you can wear.

What Will Happen If I Don’t Have My Neuroma Treated?
It is difficult to predict the sequelae and rate of progression of an untreated neuroma. Usually if a neuroma is untreated the following occurs:

• Growth of the neuroma
• Increased discomfort in the area
• Inability to wear certain shoes
• Inability to perform some job duties
• Need for surgical removal

Conservative Treatment
Usually, conservative therapy is attempted prior to surgical intervention. Conservative options include the following:

• Tie shoes with a wide toebox
• Orthotics (see next page)
• Padding
• Injections of local anesthetic and/or corticosteroids
• Physical therapy

Conservative treatment generally has a 50% chance of relieving symptoms. See us as soon as possible after symptoms begin - early conservative treatment improves your chances of avoiding surgery.

Custom Orthotics and Neuromas
Custom functional orthotics, if properly prescribed and fitted, can help relieve the symptoms of a neuroma.

Orthotics for neuromas are prescribed specifically to help take weight off of the painful area of the foot and to reduce motion of the foot in that area. Orthotics do not get rid of a neuromas or make it smaller. They can play an important role, however, in protecting the area so that other treatments have a greater chance of success.

In order to ensure best outcomes from your orthotics we first perform a detailed examination, including slow motion video analysis, of how you walk and how your feet work. A mold of your foot is then taken in a very specific position and the orthotic devices are prescribed in a manner to best reduce force and trauma to the area of your neuroma.

When Is Surgery Indicated?
When conservative therapy has failed to provide adequate relief of symptoms or conservative treatment options are impractical.

What Is Involved In Neuroma Surgery?

Surgery is usually performed under local anesthesia with IV sedation. After surgery you will have to keep your foot dry for two weeks. Generally neuroma surgery allows for early weight bearing and protection in some type of post op shoe gear for three to four weeks. The severe nerve pain is relieved almost immediately after surgery. Some neuromas may reoccur, but this is rare.

All pages on this website © 2008
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.