What Is a Neuroma?
A neuroma is a non-cancerous (benign) tumor that grows from the fibrous coverings of a nerve that can occur in any place of the body. The most common neuroma in the foot is called Morton’s neuroma, which occurs between the third and fourth toes near the ball of the foot. It’s good to note however that there is no tumor formation in Morton’s neuroma. Instead there is a thickening of the nerve. The thickening of the nerve that defines this neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, causing pain.
Poorly fitting or constricting shoes can contribute to Morton’s neuroma. It is more common in women who habitually wear high-heeled shoes or in men who are required to wear tight (constrictive) footwear.
The exact cause of Morton’s neuroma is not known. It is thought to develop as a result of long-standing (chronic) stress and irritation of a plantar digital nerve. This may be due to the nerve being squashed (compressed), rubbed, or stretched.
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot deformities—bunions, hammertoes, flatfeet or more flexible feet—are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury or other type of trauma to the area may also lead to a neuroma.
If you have a Morton’s neuroma, you may have one or more of these symptoms where the nerve damage is occurring:
- Tingling, burning or numbness
- A feeling that something is inside the ball of the foot
- A feeling that there is something in the shoe or a sock is bunched up
The progression of a Morton’s neuroma often follows this pattern:
- The symptoms begin gradually. At first, they occur only occasionally when wearing narrow-toed shoes or performing certain aggravating activities.
- The symptoms may go away temporarily by removing the shoe, massaging the foot or avoiding aggravating shoes or activities.
- Over time, the symptoms progressively worsen and may persist for several days or weeks.
- The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
To arrive at a diagnosis, your foot doctor or podiatrist will obtain a thorough history of your symptoms and examine your foot. During the physical examination, the doctor will attempt to reproduce your symptoms by manipulating your foot. Other tests or imaging studies may be performed.
Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may help you avoid surgery.
In developing a treatment plan, your doctor will first determine how long you have had the neuroma and will evaluate its stage of development.
For mild to moderate neuromas, treatment options may include:
- Padding. Padding techniques provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
- Icing. Placing an icepack on the affected area helps reduce swelling.
- Orthotic devices. Custom orthotic devices provided by your foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve.
- Activity modifications. Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
- Shoe modifications. Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
- Injection therapy. Treatment may include injections of cortisone, local anesthetics or other agents.
When Is Surgery Needed?
Surgery may be considered in patients who have not responded adequately to nonsurgical treatments. Again, your doctor will determine the approach that is best for your condition. The length of the recovery period will vary.
Regardless of whether you have undergone surgical or nonsurgical treatment, your doctor will recommend long-term measures to help keep your symptoms from returning. These include appropriate footwear and modification of activities to reduce the repetitive pressure on your foot.
Reference source: https://www.foothealthfacts.org/conditions/morton-s-neuroma-(intermetatarsal-neuroma)