A neuroma is one of the commonest causes of pain in the ball of the foot. A neuroma is a swelling which develops on a nerve. Most commonly this occurs between the third and fourth toes but can also occur between the second and third toes.
Nerves swell and finally develop a “neuroma” due to repeated injury. This can occur when the nerve becomes trapped between the metatarsal bones of the forefoot. It classically occurs between the third and fourth toes. It can also occur between the second and third toes. It can be aggravated by crowding the forefoot such as occurs with tight fashion shoes.
As the nerve enlarges it becomes more easily entrapped and so the condition usually worsens with time.
Typically there is pain in the ball of the foot. This is often described as “burning”. Often the pain radiates into the toes. The pain may be episodic. It may feel like a stone under the foot and sometimes there is a sharp “snap” felt as the neuroma clicks between the bones.
Examination usually reveals tenderness in the web space between the affected toes. Your doctor will squeeze the foot from side to side to see if he can elicit a “snap” as this is virtually diagnostic. Often there will be decreased sensation over the affected toes.
Neuromas do not show on plain x-rays. They can be detected with special scans but generally this is not required as the diagnosis can be made clinically.
There are essentially three avenues of treatment:
- Shoe wear A wide soft shoe will be helpful. Sometimes a pad designed to take pressure off the area and spread the metatarsal bones will improve the situation.
- Cortisone injection An injection of local anaesthetic and cortisone can be very useful. If the local anaesthetic temporarily abolishes pain then this tends to confirm the diagnosis. At the same time the cortisone may reduce swelling and give a longer lasting relief. The response to cortisone is very individual. The maximum number of injections is usually 3 separated by at least 4 weeks between each.
- Surgery If the above measures fail, then surgical resection of the neuroma is indicated. Most reports indicated 85% success rate after surgery. This still leaves a number with residual pain. Often this is due to regrowth at the cut end of the nerve (a “stump neuroma”). This occasionally can require further surgery.
- Neuroma surgery is usually a day case (or one night stay if there is limited home help).
- Neuroma surgery can be done under ankle block (patient awake) or general anaesthetic.
- Your doctor may make his incision on top of the foot to avoid painful scars on the sole.
- You will be discharged from hospital with a crepe bandage on your foot and a post operative sandal for support. (This sandal is supplied by the hospital).
- You will be able to bear weight on the sandal, but for limited periods only.
- Generally for the first week it is best to rest and keep the foot elevated.
- The bandage and skin suture will be removed at the first post-operative appointment in 7-10 days.
This material has been produced as a reference guide only and should not be used in place of a consultation with a qualified medical practitioner.