Neuroma

A neuroma is an inflamed nerve between the the heads of the metatarsal bones, often caused by rubbing between the metatarsal heads. This most commonly occurs between the 3rd and 4th metatarsals, and causes pain around the ball of the foot, which often includes tingling, burning or numbness of the 3rd and 4th toes.

Symptoms

The symptoms of a neuroma are listed below. These gradually increase in severity. At the beginning of developing a neuroma, the irritation will only occur when performing certain activities. The symptoms will fluctuate as the activity and shoewear are changed throughout the day. Over time, these symptoms will become more bothersome.

  • Pain
  • Tingling or numbness
  • Swelling
  • A sensation of “walking on a pebble”

It is important to catch neuromas early, to avoid permanent nerve damage.

Treatment

Nonsurgical:

  • Orthotics- Provides the support necessary to reduce pressure and compression.
  • Icing- Reduces inflammation.
  • Activity modifications- Activities that put repetitive pressure on the nerve should be avoided.
  • Shoe modifications- Shoes with a wide toe box help to avoid excess pressure on the nerve.
  • Padding- Provides support for the metatarsal arch by avoiding excess pressure.
  • Injection therapy- Alcohol or cortisone injections will help with pain tolerance.

Surgical:

Surgery is done to remove the inflamed/enlarged section of the nerve, with the goal of alleviating the pain and burning. A neurectomy procedure will be done to remove the inflamed nerve, and occasionally releasing additional tight ligaments, if necessary. A full recovery is common around a month after the procedure, but numbness of the toes and affected area can take longer to resolve. In some cases numbness can even be permanent.