A neuroma is a painful condition resulting from thickened or inflamed nerve tissue. The most common form, known as Morton’s neuroma, typically affects the ball of the foot, often between the third and fourth toes. This thickening causes the nerve to become compressed and irritated, leading to discomfort. Treatment follows a spectrum, beginning with conservative, at-home measures and progressing to professional medical procedures and, in resistant cases, surgical intervention. The goal of any treatment is to reduce nerve irritation, alleviate pain, and restore comfortable mobility.
Understanding Neuroma and Initial Self-Care
Morton’s neuroma is characterized by symptoms such as a burning sensation, tingling, numbness in the toes, or the distinct feeling of standing on a pebble or a folded sock inside the shoe. This irritation occurs because the nerve is squeezed between the metatarsal bones, a situation often aggravated by improper footwear. Addressing the condition early with simple, self-administered care can allow the inflamed nerve to recover and may prevent the need for more invasive treatments.
The primary step in self-care involves making immediate changes to footwear. Selecting shoes with a wide toe box is important to allow the toes to spread naturally, which reduces the compressive force on the nerve. It is equally beneficial to avoid high-heeled shoes, especially those over two inches, as they shift body weight onto the forefoot, dramatically increasing pressure on the affected area.
Over-the-counter padding can be used to offload pressure from the painful site. Specifically, a metatarsal pad placed just behind the ball of the foot helps to separate the metatarsal heads, creating more space for the irritated nerve. Rest and the temporary avoidance of high-impact activities, such as running or jumping, can also give the nerve a chance to calm down. For short-term pain and inflammation management, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium are commonly used. Applying ice or a cold pack to the painful region for 10 to 20 minutes at a time can help reduce local swelling and temporarily numb the area.
Non-Surgical Medical Interventions
When self-care methods do not provide sufficient relief, a physician may recommend medical interventions. Custom-molded orthotics represent a step up from over-the-counter pads, as they are designed specifically to redistribute pressure across the foot. These devices incorporate precise metatarsal support to elevate and separate the metatarsal bones, effectively decompressing the nerve as the patient walks.
Corticosteroids, a powerful anti-inflammatory medication, are commonly injected directly into the area around the neuroma. Corticosteroid injections aim to reduce the swelling and inflammation of the nerve tissue, which can lead to significant, though often temporary, pain relief. Multiple injections may be administered over time, but the total number is usually limited due to potential long-term side effects on surrounding tissues.
For cases unresponsive to steroid injections, a neurolytic injection, such as alcohol sclerosing, may be used. This procedure involves injecting a small amount of dehydrated alcohol solution to chemically destroy the nerve tissue, thereby hindering its ability to transmit pain signals. This chemical neurolysis is typically performed as a series of injections over several weeks. It offers a less invasive option that attempts to achieve the effect of surgical nerve removal.
Cryoablation uses extremely cold temperatures to destroy the nerve tissue. A specialized probe is inserted next to the neuroma, where it freezes the nerve, causing it to degenerate. This method is distinct because it aims to preserve the structural sheath around the nerve, potentially offering a better environment for healing and reducing the chance of a painful recurrence.
Surgical Approaches and Recovery
Surgery is reserved for neuromas that remain persistently painful despite the failure of non-surgical treatments. The most common surgical procedure is a neurectomy, which involves the removal of the affected segment of the nerve. This is typically performed through a small incision on the top of the foot, known as the dorsal approach, which allows the patient to bear weight relatively quickly post-surgery.
The plantar approach, on the sole of the foot, is a less common incision, typically selected when a previous dorsal neurectomy failed. The neurectomy procedure often includes cutting the deep transverse intermetatarsal ligament to gain access to the nerve, which also helps to decompress the area. A complete recovery from a primary neurectomy often takes between three to four weeks before a return to normal activity, though full resolution can take longer.
Alternatively, nerve decompression surgery (external neurolysis) is performed without removing the nerve itself. This procedure involves surgically releasing the surrounding structures, such as the deep transverse intermetatarsal ligament, which are pressing on the nerve. Cutting this ligament gives the nerve more room to move and relieves the mechanical irritation causing the pain.
A potential complication following a neurectomy is the formation of a stump neuroma, where the cut nerve end attempts to regenerate and forms a painful mass. Surgeons try to mitigate this by implanting the cut nerve end into surrounding soft tissue or bone to cushion and protect it. Post-operative care includes a period of non-weight-bearing or limited weight-bearing activity, and physical therapy may be necessary to manage scar tissue and restore foot strength and flexibility.