The following are some of the ways my patients have described the pain from a neuroma: “It feels like I’m stepping on a pebble,” “I feel like my sock is wadding up under the ball of my foot,” “I feel a burning pain between my toes,” and sometimes “my 3rd and 4th toes are numb – is it diabetes?” Well, it’s not diabetes (in most cases). It is most likely a common condition called a Morton’s Neuroma, something we podiatrists treat daily.
What exactly is a Neuroma?
It’s actually a bit of a misnomer. It is not a tumor at all. It is in fact a swollen, inflamed nerve located between the bones at the ball of the foot. It can be between the 2nd and 3rd toes or the 3rd and 4th toes. The nerve can actually become so enlarged that it pushes the toes apart when you stand up (called a Sullivan’s sign). It is seldom found between the big toe and 2nd toe or between the 4th and 5th toes.
Who gets it?
Mostly adults, but occasionally I have seen it in teens. Women are more likely to suffer from a neuroma. Perhaps due to the shoes they wear. High heels can cause the foot the slide down in the shoe and compresses the ball of the foot in the toe box. Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma which can also lead to a neuroma. Foot deformities like bunions, hammertoes and flatfeet can also be predisposing factors.
So, how do we diagnose it?
In most cases, clinical findings alone are sufficient. A positive mulder sign is when the doctor squeezes the ball of the foot with one hand, while concomitantly putting pressure on the interdigital space (on the bottom of the foot between the two metatarsal bones) with the other hand. A click can be felt as well as pain in most cases. An ultrasound and/or MRI can also be used for diagnostic purposes, but the neuroma can sometimes be missed with these imaging studies.
How do we treat it?
A custom orthotic with a metatarsal pad included to relieve pressure from the neuroma is usually the first line treatment. Steroid injections can also be very helpful to decrease the inflammation. Another kind of injection called a sclerosing injection (alcohol based) can also be used to deaden the nerve. These injections are usually given in a series (every 10 days or so – anywhere from 5 to 10 total). If conservative care fails there are also surgical treatment options. There are two kinds of surgery for neuromas: one releases the ligament compressing the nerve and the other involves removing the nerve. Happily, most people recover with conservative care alone and do not need surgery but if conservative care fails surgery can be a welcome relief from the constant pain.