The logo on my company t-shirt caught the eye of the stranger in front of me at the craft store check-out line. “Do you work at a foot clinic?” he asked. Affirming that I did, he eagerly asked about treatment options for neuromas. He’s been struggling with foot pain and was hoping for some new solutions.
A neuroma, or more specifically a Morton’s neuroma, is caused from localized thickening of the nerve tissue. The most common area for this to occur is between the 3rd and 4th metatarsal heads (the bones that lead up to our toes). Those two bones in particular are more likely to be close to the same length causing the condyles at the head of the bones to squeeze the interposing soft tissue where the nerve lives. Additionally, the nerve passing through that interspace is formed by two nerves that come together proximal to the space and is a bit thicker than the nerves in the adjacent spaces. When these factors are combined with external causes, such as tight shoes, repetitive activity or poor foot biomechanics, the nerve can become pinched and irritated. This irritation causes the nerve to thicken, which then causes the nerve to be more easily pinched… And the circular cause and effect continues.
Treatment consists of efforts to relieve pain and prevent recurrence. A cortisone injection may be recommended to reduce the inflammation. In order to prevent ongoing irritation to the nerve, a change in shoe style or use of orthotics may be recommended. In cases where relief is not obtained, surgery may be required. However, a vast majority of my patients never require surgery.
Not every pain in the ball of the foot is a neuroma, and careful examination is required to differentiate this from the much more common pain of metatarsalgia.