Neuromas rank high in the list with some of the most common pathologies I treat. A neuroma is an inflamed or irritated nerve that supplies the toes, most often occurring between the 3rd and 4th toe.
What causes a neuroma?
There are many reasons the nerve can become inflamed. Repetitive activities that require a person to be on their forefoot such as going up and down a ladder or operating a machine press with a foot are examples. Obviously running can lead to an overuse injury creating inflammation of the nerve, especially if you are wearing a tight shoe.
What are the symptoms of a neuroma?
Most patients will complain of numbness and tingling to the 3rd and 4th toe that is also accompanied by pain and burning. The burning may encompass the entire ball of the foot but is more concentrated to the base of the toes where the actual neuroma is. Patients will typically describe the feeling of walking on a pebble or stone.
How to treat a neuroma.
As with any inflammatory condition, rest will always help. Combining rest with ice, NSAIDS, and wearing a wider shoe may resolve the the situation.
Should you stop running?
Very rarely do I tell someone with a neuroma to stop running unless they are experiencing pain so severe that it alters their gait. Running can obviously make it worse, but you will not be “damaging” your foot unless you begin to compensate by running with a limp.
Cortisone injections for a neuroma.
Injecting a neuroma is a safe option for trying to resolve this condition. The goal of doing this is to calm the inflammation creating the pain. This can either improve the condition temporarily or resolve it permanently. In my practice I will give one injection and possibly a second if the first doesn’t resolve the pain. Usually these are spaced apart by several weeks. If a second doesn’t fix it, then it’s probably too large to be treated by conservative therapy.
Orthotics and neuromas.
While it is possible to treat a neuroma with a shoe orthotic it is very difficult to successfully accomplish. The goal is to splay the metatarsal heads with a pad incorporated into the forefoot of the orthotic device. If placed in the wrong position it can aggravate the situation because of putting more pressure on the nerve. Placing an insert like this into a running shoe can make the shoe excessively tight making the situation worse.
Surgery for a Neuroma.
When all else fails, surgery can become the final option for treating a neuroma is surgical excision. This is a simple 15 minute procedure that is performed in an operating room setting with conscious sedation. By removing the inflamed nerve the pain will resolve but a feeling of numbness can remain to the involved toes. Most patients say this numbness far outweighs the pain that was previously present.