Do you have pain in the ball of your foot?  It could be a neuroma.

What Is A Neuroma?

A neuroma is commonly referred to as a Morton’s neuroma in the foot.  It is named after the man who “discovered” and documented this ailment and this specific neuroma occurs between the 3rd and 4th toes in the foot, referred to as the 3rd innerspace.  It is a benign swelling of the nerve tissue that travels between the toes in the foot, or an interdigital nerve.  The swelling of the part of the nerve causes the discomfort. A neuroma is most common in the 3rd interspace between the 3rd and 4th toe, and you feel it more on the bottom of the foot than the top of the foot, and you may feel it between the toes.  However, a neuroma can occur in the 2nd innerspace between the 2nd and 3rd toe as well, and even between the other toes, but less commonly.

What Are Some Symptoms?

The most commonly described symptoms have to do with numbness or tingling, or both.

Tingling in the toes - Sometimes you get pain in the ball of your foot. It can be aching, nagging, or some people describe it as an “electic shock” or a “zinger” traveling to the toes.  If these sensations seem familiar to you, it may be a neuroma.

Feels like stepping on a pebble – the irritated nerve may feel like you are stepping on a piece of sand or a pebble, but then you look in your shoe, and there is nothing there.

Like a bunched up sock – just like the feeling of stepping on something but there is nothing in your shoe, you may feel like the sock is “bunched up” under the ball of your foot even when you are not wearing socks.

No pain at rest – When there is no pressure on the nerve, then the pain resolves, such as when you are at rest. 

Wider shoes may relieve the pain, while tighter shoes or socks may aggravate the area and make the pain worse. 

What Causes A Neuroma?

There are various reasons why a person would get a neuroma in the foot. These include:

Shoe Gear:   Many times, it can be due to tight shoes (high heels with a pointed toebox or very narrow toe box can be a huge culprit! Because of the shape of the shoe, there is less room in the toe box.  This causes the toes and the long bones of the foot (the metatarsal bones) to rub up against each other and against the nerve running between them, causing irritation.  The nerve in turn is inflamed, and this causes the pain felt on the ball of the foot that sometimes travels to the toes.

Certain sport activities: Although many people active in sports may never have symptoms of a neuroma, there are theories that some sports with increased pressure on the ball of the foot including running or jumping may have increased incidents of neuromas.  However patients who are not active in these sports can get neuromas as well.

Foot Structure:  You can’t get away from your genes!  If the shape of your foot causes the long bones of the feet, or the metatarsals, to grow closer to one another, there may be more incidents of neuroma formation as the nerve that travels between those metatarsals can get trapped and irritated.

How Is It Diagnosed?

Your doctors at Prairie Path Foot and Ankle Clinic will perform a thorough history and lower extremity physical.  Radiographs (X-Rays) will be taken to examine your bone/foot structure.  The bone structure and how close certain bones are to each other may have an influence on the formation of a neuroma.  Also, an X-ray of the foot will rule out any bony abnormalities, such as a stress fracture of one of the metatarsals, or sesamoiditis, which is swelling of the sesamoid bones (2 little floating bones under the base of the big toe).  It can also rule out any joint problems/arthridities or more rarely, and AVN (avascular necrosis) of the metatarsal head.  If there is a lack of a bony reason for the pain, then this points towards a diagnosis of a neuroma.  In addition, during physical exam, your doctor may squeeze the affected bases of the digits. At this time, it may be diagnosed with advanced imaging (diagnostic ultrasound or an MRI ) with its exact measurements. An ultrasound or MRI will also be able to rule out any other soft tissue abnormality causing the pain, such as a capsulitis or inflammation of the joint at the base of the toe.

When Should I Seek Treatment From My Doctor?

You should seek treatment right away! It is important to start a treatment plan right away. The longer you let something go, the worse the pain and the longer the treatment plan.  Plus remember, pain in your foot is not normal!

How Is It Treated?

 The first line is to decrease the forces that are irritating the nerve.  Your doctor will likely make a removable strapping for the foot with padding that will deweight the area, thus relieving the pressure and in turn relieving the pain.  She may also give you a prescription for oral medications to decrease the swelling, such as an oral anti-inflammatory.  The next step would be physical therapy to try to reduce the swelling, or an ultrasound guided cortisone injection or alcohol sclerosing injection into the area.  The cortisone and ant-inflammatory medication may work, but it is imperative at this time to obtain custom orthotics, or inserts, in order to alter the biomechanics of the foot to reduce pressure in that area.  If all of these treatment options fail, then surgical intervention is needed.  At Prairie Path Foot and Ankle Clinic, we rarely have to take any patient for surgical intervention as our conservative therapy including custom orthotics help get rid of the pain. 

How Can I Prevent It From Coming Back?

The best way to prevent this neuroma from bothering you again is to pay attention to what caused it in the first place. Custom orthotics are the key to continue to deweight the affected area.  This may prevent the problem from returning.   If you correct the biomechanics of the foot, then the areas of irritation are no longer aggravated, and your foot can function as biomechanically stable as possible. . 

So don't delay, make your appointment with one of our doctors today!  Remember, it is not normal to live with foot pain, come to our office for a thorough exam, diagnosis, and treatment plan and you will be on your way to becoming pain-free.