What are they?
Neuromas are nerve
irritations that involve typically an enlarged or swollen segment of the
nerve itself. In some cases, these neuromas can actually resemble a small
grape in size and can cause significant discomfort
to the patient. The individual with such an affliction will often complain
of numbness, tingling, and/or burning sensations, which radiates into or
involves two adjacent toes. Sometimes neuromas can be exquisitely painful.
Most patients relate having to remove the shoe and rub their feet. In most
cases, the neuroma will be located between the third and fourth digits of
one foot with burning sensation involving the bottom of the metatarsal fat
pad and the two involved toes. A second commonly involved site is between
the second and third toes of the foot. The typical neuroma usually does not
have redness, heat, swelling, or any apparent range of motion loss. Pressure
on the bottom of the foot with manipulation of the involved digits will
frequently produce the painful symptoms. Neuromas, generally speaking, do
not go away on their own but usually require some form of professional care.
What causes them?
The most frequently
agreed upon cause of neuromas is that of trauma or injury. This trauma might
be the acute kind like a twisting of the foot or stepping on something or it
might be the chronic kind like repeated micro-trauma from an excessively
flat foot. The problem however, is that the onset of the neuroma pain might
not appear for quite some time after the noted trauma. In other words, an
injury to the foot may have occurred some two or more months prior to any
neuroma formation but nevertheless, a cause and effect relationship still
exists. Shoes might aggravate an existing neuroma but usually do not play a
How do you treat them?
The usual range of
conservative care through surgical procedures applies in the approach to
neuroma care. Appropriate shoe selection and modifications is a good start
in trying to relieve pressure and allow additional room for the foot during
walking. Various forms of physical therapy and localized injections of
anti-inflammatory medication can frequently be helpful in the treatment of
annoying problem. Surgical procedures armed at identifying and removing the
involved section of irritated nerve can provide a more permanent resolution
in many cases. A few new treatments have been used over the past few years.
The first is a series of neurolytic injections where an alcohol is injected
into the nerve to try to destroy it this has not been very successful. The
second is a surgical approach to try to release the ligament over the
neuromal. This also has had limited success. A discussion of possible
recurrence rates, disability involvement, and procedural expectations should
take place between the patient and foot specialist prior to surgery.