The term 'neuroma' refers to a painful swollen nerve that can occur commonly in the plantar digital nerve endings at the bottom of the foot. The interspace between the third and fourth toes is the most common location followed by the interspace between the second and third toes. Why neuromas form is not entirely clear. The most likely cause seems to be an irritation of the nerve over a long period of time. Irritating factors such as constricting footwear, walking on hard surfaces, and previous injuries may be sources of causation. Prolonged irritation of the tissue in the region of the nerve can cause swelling of the nerve. With swelling, the nerve becomes more prone to irritation and thus a cycle of inflammatory pain and swelling ensues.
One of the most common symptoms of a neuroma is pain localized to the bottom of the foot between the metatarsal heads. Symptoms may increase with walking, and be relieved by resting the foot. The pain or numbness feeling is usually localized to the bottom of the foot, but will often radiate into the toes of the involved interspace. Patients may complain of having the feeling of a marble or stone underneath the ball of the foot. Some patients describe a knot moving around on the bottom of the foot, which causes sharp pain.
There are multiple nonsurgical treatment options that can be attempted for pain relief from a troublesome neuroma. Utilization of a cushioned athletic shoe with a flat heel and a wide toe box to keep pressure off the toes is recommended. A stiff-soled shoe or a rigid insert may help splint the forefoot and decrease bending forces on the toes. Treatment with metatarsal bar pads placed on a cushioned insole can provide relief by decreasing pressure on the nerve. Anti-inflammatory medications may help decrease painful inflammation and swelling at the neuroma. Sometimes an injection into the involved interspace with a steroid can decrease pain substantially. Injections may also be used diagnostically to determine the location of the neuroma when it is difficult to locate where the pain is emanating from.
When pads, injections, oral medications, and footwear modifications are unsuccessful, surgical intervention may be beneficial. Neuromas are generally successfully treated with excision of the painful swollen nerve. Patients may note decreased sensation in the area where the nerve was formerly located, but there is also considerable resolution of painful symptoms. The numb area is generally not bothersome for patients and may get smaller with time.
Following surgery, careful postoperative care is needed in order to protect the toes while healing occurs. Patients usually go home the same day of surgery. Stitches are usually removed at 2-3 weeks. You will likely be able to bear weight on your heel the first week after surgery. Although we will allow you to put weight on your heel, to help insure a good outcome, we will ask you to walk flat-footed for about 6 weeks without putting much pressure on your toes. A postoperative shoe or walking boot with forefoot taping will offer additional protection. Transitioning back into a regular shoe usually occurs around 6 weeks after surgery, and at this point you can begin walking with a more normal gait pattern. Impact activities, such as jogging, may be done safely around 8-12 weeks after surgery. Time off from work depends on occupation but prepare to take off at least 1 week because elevation of the foot is very important in the immediate postoperative period.