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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 a numbness, tingling, and/or burning sensations, which radiates into or involves two adjacent toes. 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. 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 never the less, a cause and effect relationship still exists. It is the opinion of this author that shoes might aggravate an existing neuroma but do not play a causative role.

How do you treat them?

The usual range of conservative care through surgical procedures apply in the approach to neuroma care. Appropriate shoe selection and modifications are good starting points 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 this annoying problem. Surgical procedures aimed at identifying and removing the involved section of irritated nerve can provide a more permanent resolution in many cases. A discussion of possible recurrence rates, disability involvement, and procedural expectations should take place between the patient and foot specialist prior to surgery.

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