NEUROMA

A neuroma in the foot is a benign thickening of the plantar nerve of the foot most frequently occurs between the third and fourth metatarsal bones in the ball of the foot.

For some reasons the nerves are more prone to get entrapped and irritated at this location. The nerve tissues responds with creating enlargement of it's surrounding protective nerve tissue that leads to more entrapment and compression of the nerve itself by its own thickened tissue which may cause pain and eventually nerve damage.

 

Symptoms

Neuroma symptoms usually begin gradually with occasional pain when wearing narrow shoes or performing certain activities. Symptoms of neuroma may include:

  • Burning, tingling or numbness

  • Pain

  • Abnormal sensation that something is inside the ball of the foot​

  • The symptoms may become more intense as the neuroma enlarges and permanent nerve damage occur.

 

Causes

  • Neuroma can be caused by any condition that leads to irritation and compression of the nerve. This may include wearing narrow pointed shoes or high heels that forces the toes together. 

  • Activities with repetitive irritation to the ball of the foot such as running or court sports carries more potential to develop neuroma to the foot.

 

Diagnosis

Your doctor will need to obtain a thorough history of your symptoms and examine your foot. During the physical examination, your doctor will attempts to reproduce your symptoms by manipulating your foot. Imaging studies may be performed to rule out bone pathology. MRI may be ordered to confirm diagnosis of neuroma.

It is advised to see your doctor early in the development of symptoms. Early diagnosis of a Morton’s neuroma increases chances of resolving the symptoms and help prevent progression of the condition avoiding the need for surgical intervention.

 

Treatment

  • Treatment approaches vary according to the severity of the condition.

  • For mild to moderate neuromas, treatment options may include:

  • Padding. Metatarsal padding provides support for the metatarsal arch decreasing the pressure and on the plantar nerves and decreasing the compression when walking.

  • Icing. Ice packs application helps reduce swelling.

  • Orthotic devices. Custom orthotic devices with built in metatarsal padding provide the support needed to reduce pressure and compression on the nerve.

  • Activity modifications. Activities that may cause repetitive pressure on the neuroma should be avoided.

  • Shoe modifications. Shoes with a wide toe box are advised. Avoid wearing narrow pointed shoes or 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 to reduce inflammation, local anesthetics to alleviate pain or other neurolytic agents to dissolve the enlarged tissue.

 

Prevention

Wither the condition is managed surgically or non-surgically, it is recommend to continue preventive measure to avoid symptoms recurrence. Appropriate footwear, orthotic with metatarsal pad and modification of daily activities to avoid nerve condition is advised.

 
 

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