A neuroma in the foot is a thickening of nerve tissue, most commonly occurring between the third and fourth toes, often called Morton’s neuroma. This thickening is not a tumor, but an enlargement of the nerve due to irritation or compression. Individuals with a neuroma often experience pain in the ball of the foot, feeling like walking on a pebble or bunched-up sock. Other common symptoms include burning, tingling, or numbness in the affected toes. This article explores treatment options for neuromas.
Initial Approaches to Treatment
Managing a neuroma often begins with conservative, non-invasive methods to reduce pressure and inflammation on the affected nerve. Adjusting footwear is a primary step, involving selecting shoes with a wide toe box and low heels to avoid compressing the toes. High heels and narrow, pointed shoes can exacerbate symptoms by forcing toes together and increasing forefoot pressure.
Orthotics, custom or over-the-counter inserts, can help redistribute pressure across the foot. These supports alleviate stress on the nerve by improving foot mechanics and providing better arch support. Metatarsal pads, placed behind the ball of the foot, lift and separate the metatarsal bones, creating more space for the irritated nerve.
Resting the foot and applying ice can reduce inflammation and pain. Limiting activities that aggravate the condition, such as prolonged standing or high-impact sports, allows the nerve to recover. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can provide temporary relief by reducing pain and swelling.
Advanced Non-Surgical Options
When initial approaches do not provide sufficient relief, healthcare providers may recommend more advanced non-surgical interventions. Corticosteroid injections, delivered directly into the affected area, reduce inflammation around the nerve, offering temporary pain relief. Multiple injections might be necessary, and their effectiveness can vary.
Alcohol sclerosing injections involve injecting a solution of alcohol and anesthetic around the neuroma, aiming to chemically ablate or shrink the nerve tissue. This process typically requires a series of injections over several weeks. Physical therapy can play a role, focusing on exercises and stretches that improve foot flexibility, strength, and overall mechanics to alleviate nerve irritation.
Cryoablation uses extreme cold to destroy nerve tissue, effectively stopping pain signals. A small probe is inserted near the neuroma, and cold temperatures freeze and damage the nerve. Radiofrequency ablation uses heat to achieve a similar outcome, employing radiofrequency energy to create a lesion on the nerve, disrupting pain transmission.
Surgical Considerations
When non-surgical treatments fail to provide lasting relief, surgical intervention may be considered. The most common surgical procedure for a neuroma is a neurectomy, involving surgical removal of thickened nerve tissue. This procedure is typically performed through an incision on the top or bottom of the foot to access and excise the affected nerve.
Another surgical option is nerve decompression, where the surgeon releases surrounding structures that pressure the nerve without removing it. This creates more space for the nerve, reducing irritation. Following surgery, a recovery period is necessary, often involving non-weight-bearing periods and physical therapy to restore strength and range of motion. Potential risks associated with foot surgery include infection, scarring, and persistent numbness or pain.
Preventing Recurrence and Long-Term Care
Preventing a neuroma from returning or managing its symptoms long-term involves consistent attention to foot health and lifestyle adjustments. Continuing to wear appropriate footwear with a wide toe box and low heel is important, even after symptoms subside. Avoiding narrow or high-heeled shoes helps prevent re-aggravation.
Regular use of orthotics or metatarsal pads, if beneficial during initial treatment, can maintain proper foot alignment and reduce pressure on the forefoot. General foot care practices, such as regular stretching and good circulation, contribute to overall foot health. Monitoring symptoms and seeking medical advice promptly if pain or discomfort returns is important for early intervention. Maintaining a healthy weight and modifying activities to avoid prolonged high-impact stress on the feet can further support long-term management.