What is Neuroma
A common cause of forefoot pain presenting to Podiatrists is Neuroma. It is often due to swelling of the nerve as a result of compression/trauma or entrapment. The most common site is the ball of the foot.
Symptoms
Patients that present to Podiatrists often complain of ?a pebble in my shoe? or ?numbness? ?burning?? in one or more toes.
The 3rd and 4th toes are most commonly affected, this is known as Morton?s Neuroma. The pain can be severe and radiate beneath the foot. A clicking/popping is sometimes felt as it gets aggravated.
Neuroma is commonly caused by abnormal movement of the long bones behind the toes called metatarsal bones.
It can be aggravated by tight fitting shoes, sports and activities which put pressure on the toes.
It can be a structural problem-long metatarsal bones, flat foot, high arch, ankle restriction. Your Podiatrist can help correctly determine the cause of your forefoot pain.
Anatomy
A small nerve passes between the between the spaces of the metatarsals. At the base of the toes the nerve splits forming a ?Y? and enter the toes. It is in this area the nerve can get pinched (entrapped) and swells forming the neuroma.
Neuroma’s are commonly seen in the 2nd and 3rd web space and 3rd and 4th web space. They can be present in one or both feet. They are rarely between the 1st and 2nd and 4th and 5th toes.
Neuromas can be seen into the heel nerves resulting in heel pain. They can result after trauma or injury to another nerve in the foot also (though less commonly).
Diagnosis
A through history is taken by your Podiatrist and appropriate physical examination. Other causes such as arthritis, stress fracture, ligament damage, ?tendonitis, or nerve damage further up the foot should be ruled out.
Occasionally an Xray is taken to rule out arthritis or stress fractures and bony causes.
An Xray is not the standard in diagnosis of the actual Neuroma. It cannot be seen on Xray as it is a soft tissue mass (not bone). ?Occasionally ultrasound can be used to determine the size of the Neuroma but it is not first line of treatment as it ?does not often alter the Podiatrists treatment regime.
Treatment
Make an appointment with our Miranda based Podiatrist Karina Schuberg if you suspect Neuroma. Karina has over 16 years experience dealing with complex forefoot issues.
Treatment can consist of the following-
- Assess contributing factors
- Pain management ice/heat
- Footwear review
- Padding/strapping (metatarsal pads)
- Functional foot orthoses to prevent aggravation from metatarsal bones
- Local anaesthetic? injection for hydro dissection of the nerve
- Cortisone injection (referral) to shrink the swelling
In very rare cases a referral to Podiatric surgeon may be required. This is often last line if there is permanent nerve damage. Our Podiatrist at Sports Medicine Institute can assess if this is required and refer directly.
Neuroma pain can be debilitating but does not have to be permanent. See our Podiatrist Karina Schuberg at Sports Medicine Institute Miranda for management of your forefoot pain today.
