What are they?
Neuromas are irritations of the nerve that often involve an enlarged or swollen segment of the nerve itself. In some cases, these neuromas can be as large as a small grape and cause significant discomfort. Individuals with neuromas typically experience numbness, tingling, and/or burning sensations that radiate into or affect two adjacent toes. The pain can be intense, leading many to remove their shoes and rub their feet for relief. Neuromas are most commonly found between the third and fourth toes, causing a burning sensation in the metatarsal fat pad and the two affected toes. Another common location is between the second and third toes. Neuromas usually do not present with redness, heat, swelling, or loss of range of motion, but pressure on the bottom of the foot and manipulation of the toes can trigger painful symptoms. Generally, neuromas do not resolve on their own and require professional treatment.
What causes them?
The primary cause of neuromas is typically trauma or injury. This can be acute, such as a twisting injury or stepping on something, or chronic, like repeated micro-trauma from an excessively flat foot. Often, the pain from a neuroma may not appear until some time after the initial trauma—sometimes months later—yet a cause-and-effect relationship still exists. While ill-fitting shoes can aggravate an existing neuroma, they are usually not the primary cause.
How do you treat them?
Treatment for neuromas ranges from conservative methods to surgical interventions. Initial steps include choosing appropriate footwear and making modifications to relieve pressure and provide more space for the foot. Physical therapy and localized injections of anti-inflammatory medication can also be effective in managing symptoms. In cases where conservative treatments are insufficient, surgical options may be considered to identify and remove the affected nerve segment, often providing a more permanent solution. Newer treatments, such as neurolytic injections (using alcohol to destroy the nerve) and surgical release of the ligament over the neuroma, have had limited success. It is important for patients to discuss potential recurrence rates, disability implications, and procedural expectations with their foot specialist before proceeding with surgery.
