A neuroma is an inflamed or thickened segment of nerve tissue that causes significant pain and discomfort. The most commonly diagnosed type is Morton’s neuroma, which typically forms in the foot between the third and fourth toes. This condition develops from chronic irritation, pressure, or trauma to the nerve as it passes between the metatarsal bones. Symptoms often include a burning sensation, tingling, numbness, or the feeling of having a pebble or bunched-up sock beneath the ball of the foot. Treatment protocols are structured to relieve pressure and inflammation on the affected nerve, progressing from self-care to more involved medical and surgical procedures.
Initial Self-Care and Lifestyle Adjustments
The first strategy for managing neuroma symptoms involves modifications that reduce pressure on the nerve. Changing footwear is often the most impactful step. Avoiding shoes with high heels or a narrow, pointed toe box is important because these styles compress the forefoot and squeeze the metatarsal bones together.
Selecting shoes with a wide toe box and a low heel allows the metatarsal bones to spread naturally, relieving pressure on the neuroma. For symptom relief, rest is beneficial, and applying an ice pack for 10 to 20 minutes can reduce localized inflammation and pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be used temporarily to manage pain and swelling.
Non-Invasive Professional Aids
When self-care measures do not provide sufficient relief, professional non-invasive treatments are used. A specialist often prescribes custom orthotics, which are specialized shoe inserts designed to support the foot’s structure and mechanics. These devices redistribute weight across the foot and reduce the mechanical forces that compress the neuroma.
Custom orthotics frequently incorporate a metatarsal pad, a small dome-shaped insert placed just behind the ball of the foot. This pad is strategically positioned to gently spread the metatarsal bones apart, creating space for the irritated nerve and preventing compression during walking. By controlling abnormal foot motion, such as excessive pronation, orthotics help reduce the repetitive irritation. Taping or bracing methods may also be employed temporarily to offload pressure from the forefoot. Physical therapy can be beneficial, focusing on stretching and strengthening exercises to improve foot and ankle mobility and stability, which helps maintain proper foot mechanics.
Targeted Injection Therapies
If pain persists despite conservative measures, the next step involves targeted injection therapies. Corticosteroid injections, typically combined with a local anesthetic, are frequently used to provide anti-inflammatory action at the site of the neuroma. The steroid reduces swelling and irritation of the nerve, offering pain relief that can last from a few weeks up to several months.
Due to the potential for side effects like fat pad atrophy or ligament damage, practitioners limit the number of corticosteroid injections a patient receives. It is recommended to receive no more than three injections over a period of six months, with a minimum interval of four to six weeks between them. An alternative approach is alcohol sclerosing injections, which aim to chemically ablate, or shrink, the nerve tissue.
This procedure involves injecting a diluted solution of ethyl alcohol around the neuroma, causing chemical neurolysis that damages the nerve and eliminates its ability to transmit pain signals. Alcohol sclerosing requires a series of treatments, typically ranging from three to seven injections administered every one to two weeks, to achieve nerve degeneration. The procedure may result in permanent numbness in the toes supplied by the treated nerve. The treatment is often performed under ultrasound guidance to ensure precise placement of the solution around the neuroma.
Surgical Removal and Decompression
Surgical intervention is reserved for neuromas that have failed to respond to all other forms of conservative and injection-based treatments. The two main surgical procedures are neurectomy and nerve decompression. A neurectomy involves the surgical removal of the affected segment of the nerve and associated enlarged tissue.
The neurectomy procedure is often performed through an incision on the top (dorsal) of the foot to avoid placing a scar on the weight-bearing surface of the sole. While removing the nerve eliminates the source of pain, it results in permanent numbness in the area of the toes that the nerve previously supplied. A potential long-term complication is the formation of a stump neuroma, where the cut nerve end attempts to regenerate and forms another painful nodule.
Alternatively, nerve decompression surgery, also called neurolysis, aims to relieve pressure on the nerve without removing it. This is achieved by cutting the deep transverse metatarsal ligament, which connects the heads of the metatarsal bones and can compress the nerve. By releasing this tight ligament, the surgeon creates more space for the nerve to function. Recovery for either surgery involves a period in a surgical boot for four to six weeks, with a total recovery time ranging from eight to twelve weeks, and may require post-operative physical therapy.