What are neuromas?
Neuromas are enlarged, benign growths of nerves, most commonly between the third and fourth toes. They are caused by bones and other tissue rubbing against and irritating the nerves. Abnormal bone structure or pressure from ill-fitting shoes can also create the condition, which can result in pain, burning, tingling, or numbness between the toes and in the ball of the foot.
What causes neuromas?
The exact cause of neuromas is unclear. However, it is thought that the head of the bones creating the toe joints on either side of the nerve pinch the nerve, causing inflammation and thickening. Known contributing factors are tight shoes, especially slip-on shoes, high-heeled shoes and biomechanical dysfunction such as flat feet. Also, injury or foot sprains may cause a neuroma.
How do I know If I have a neuroma?
- Clinical examination by a physician (usually feels for a palpable click between the metatarsal heads)
- Diagnostic local anesthetic injection—mandatory prior to surgery
- X-ray of the foot to rule out other foot pathologies
When should you start treating your neuroma?
Neuromas should be treated if they are painful, limit activities or limit the shoes you can wear comfortably.
Conservative treatment of neuromas
- Usually, conservative therapy is attempted prior to surgical intervention. Conservative options for treating neuromas include the following:
- Lace-up shoes that fit properly and have a wide toebox
- Orthotics or over-the-counter arch supports
- Injections of local anesthetic and/or corticosteroids
- Physical therapy
Conservative treatment generally has a 50% chance of relieving neuroma symptoms. See your podiatrist as soon as possible after symptoms begin—early conservative treatment improves your chances of avoiding surgery.
When Is surgery indicated?
When conservative therapy has failed to provide adequate relief of neuroma symptoms or conservative treatment options are impractical.
What is involved in neuroma surgery?
Surgery is usually performed under local anesthesia with IV sedation. After surgery you will have to keep your foot dry for two weeks. Generally neuroma surgery allows for early weight-bearing and protection in some type of post-op shoe gear for three to four weeks. The severe nerve pain is relieved almost immediately after surgery. Some neuromas may reoccur, but this is rare.
What will happen if I don't have my neuroma treated?
Usually if a neuroma is untreated, the following occurs:
- Growth of the neuroma
- Increased discomfort in the area
- Inability to wear certain shoes
- Inability to perform some job duties
- Need for surgical removal
General neuroma Information:
- Occurs in all adult age groups
- More common in females
- Usually affects only one foot, but may affect both
- Usually affects the nerve behind the 3rd and 4th toes
Always take good care of your feet. Healthy feet allow you to be active which, as we know, has numerous benefits such as keeping weight off, maintaining and improving muscle and bone strength, and improving our emotional and mental health.
(Health24, Ncumisa Magadla, September 2011)
Learn more about your feet. Visit the feet centre.