By: Corinne Gehegan, DPM
A neuroma is a benign growth of nerve tissue that is often likened to a pinched nerve. Neuromas most often occur between the 3rd and 4th digits of the foot, however, a neuroma can develop between other digits as well. The condition may manifest as pain at the ball of the foot, burning, tingling, numbness, a sensation that the sock is bunched up under the toes, or a sensation of stepping on a marble. In the majority of cases there are no visual physical signs of the condition. Some individuals may notice that the space between the 2nd and 3rd digits or 3rd and 4th digits is greater than normal. One may be more susceptible depending on the foot type, the degree and type of activities, footwear, and trauma to the nerve. Shoes that crowd the toes and high heeled shoes are often implicated as a cause for neuroma development. Repeated stresses from certain occupations or athletic activities may be associated with development of neuromas.
Individuals who suspect that they have a neuroma should seek professional care to confirm the condition and ensure that the cause of the symptoms is not related to another type of soft tissue mass. Early treatment is optimal. Although a neuroma can not be seen on x-ray, one should be taken for a complete diagnostic picture. Individuals should have their feet measured to determine the most appropriate shoe size as the length and width of the feet may change over time.
Treatment may be as simple as changing the shoe size, wearing wider shoes, or wearing styles that do not crowd the digits and the forefoot. Soft soled shoes may provide shock absorption. Oral anti-inflammatory medication, injection therapy, topical analgesics, strategically placed padding, and orthotics resolve most cases. Injection therapy may involve cortisone to decrease inflammation or dehydrated alcohol to sclerose the nerve.
As a last resort surgical management may be entertained. Surgical management may involve the release of a ligament to decrease the degree of compression on the nerve caused by the adjacent metatarsal bones. Surgical excision of the neuroma may be performed as well. Excision of the neuroma may result in loss of sensation to the toes which the nerve supplies. A stump neuroma is a painful condition that develops from inadequate excision of the neuroma or from regeneration of the nerve at the level where it was cut. Surgical techniques may be employed to minimize the occurrence of a stump neuroma. Radio frequency ablation is also performed to eliminate neuroma symptoms. Surgical options and their associated risks and benefits can be discussed with the doctor. Surgical procedures for neuromas are performed in a same day surgery setting with an average recuperation of three weeks.
Article written by Dr. Corinne Gehegan
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