Foot Neuroma Causes and Treatments

A foot neuroma or Morton’s neuroma is a thickening or enlargement of a nerve in the foot.

The most common foot neuroma occurs on the bottom of the foot behind the toes. The most common toes affected are the 3rd and 4th toes although other areas may be involved. In some cases, a foot neuroma may be referred to as a tumor but this is incorrect as the nerve is only enlarged and technically is not a tumor. While a neuroma may be painful it is not an invasive growth or harmful to the body.

katz_neuromaA foot neuroma can develop when the foot is unstable and not functioning properly. This leads to improper movement of the muscles, tendons and joints.  Friction around the nerve is the result.  The nerve then gets irritated and trapped and begins to enlarge leading to symptoms such as numbness, burning, sharp pain and cramping. This pain may occur on the bottom or ball of the foot and into the toes.  During the early phases of a neuroma there may be only numbness.  As the condition worsens some people feel like they are walking on a pebble or that they have socks bunched up behind the toes.  These symptoms may continue as the neuroma worsens.

Other causes of a foot neuroma may be from injury to the area, thinning of the fat pad on the ball of the foot, arthritis, improper shoe styles or excessive impact exercises such as aerobics or running. Your podiatrist can evaluate you fully to determine the possible cause of your foot neuroma.

If you have a foot neuroma you may notice that your symptoms are worse while wearing shoes, especially those shoes that are tight around the forefoot or toe area of the shoe. Shoes will cause the long bones in the foot to compress the swollen nerve and lead to pain. Relief is possible by removing your shoe and massaging the area. As the foot neuroma worsens pain may be present in all types of shoes and even with simple walking.  Many people will even develop pain while walking barefoot.

The diagnosis of a neuroma involves an exam by a podiatrist. Early treatment provides better treatment outcomes. A particular portion of the exam may produce a click or crunching sensation indicating that a neuroma is present.  This is called a positive Mulder’s sign, described by the Dutch Surgeon & Podiatrist, Jacob D. Mulder  in 1951. This is accomplished by pushing both sides of the foot together while pushing up on the bottom of the foot.  The click is usually felt between the 3rd and 4th metatarsal heads and is diagnostic for Morton’s neuroma. You may even feel these unusual sensations with normal walking. This may cause the sensation of popping, clicking or crunching as the nerve is compressed between the metatarsals or long bones of the foot.  A diagnostic ultrasound is an excellent tool for identifying the neuroma and measuring the actual size. This tends to be better than MRI which may also be useful in cases where there is a question of whether there is a neuroma or some other condition such as a cyst.

The initial treatment for a neuroma may include anti-inflammatory medicine, padding, ice and support to the area. Further relief can be obtained with cortisone injections and custom arch supports or orthotic devices. This combination is often the most successful. Alternatives to cortisone injections are available and include regenerative medicine treatments.  These treatments are excellent options for long-term relief, while cortisone may be temporary and has more side-effects.

In cases where these treatments are not effective, more advanced options should be considered. Foot Cryotherapy or Cryosurgery is an excellent minimally-invasive office-based procedure that involves freezing of the nerve to give you relief.  This results in natural repair of the nerve without having more invasive surgery.  Platelet Rich Plasma and Ozone are used in combination with cryosurgery for the best long-term outcomes.

Super-pulsed laser therapy is an excellent non-invasive option that can be used alone or in combination with other treatments. Advanced Podiatry offers many advanced options to help avoid surgery. Patients travel from all over the US and other countries for the cryosurgery procedure.

If treatments noted above fail then surgery to remove the nerve would be an option. This is done at an outpatient facility and recovery may be from 4-6 weeks.

If you or someone you know suffers from a foot neuroma, call Advanced Podiatry for basic to advanced treatment options. Call Advanced podiatry today for an immediate appointment to become pain-free.

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