The term neuroma implies a painful, benign tumor of a nerve. Many people mistakenly use the term neuroma to refer to a painful, burning sensation in the forefoot (part of the foot towards the toes). In most cases the burning pain is a result of pressure on the sensory nerves coming from the toes. The pressure is usually caused by a combination of swelling in the metatarsal phalangeal joints (toe joints) and compression of the foot in footwear. The swelling in the metatarsal phalangeal joints is caused by overload of the metatarsal heads (ball of the foot). The shape of one’s foot, poor running mechanics, or muscular imbalances such as tight calf muscles or toe extensor recruitment may cause overload of the metatarsal heads.
To heal a neuroma you have only to alleviate the forefoot pressure causing the pain in the first place. A well-cushioned shoe of the type correct for your foot (see my article How do I pick a good running shoe?) can help considerably. A custom foot orthotic or shoe insert may also help to alleviate pressure. Anti-inflammatory medications may help to alleviate pain and swelling in the joints, and thereby, eliminate neuroma pain. Many patients ask about cortisone injections for neuroma pain. I do not recommend cortisone injections because they can cause atrophy of the skin and the necessary padding in the forefoot.
Traditional surgical treatments have focused excision of the inflamed nerve. This creates numbness in the toes, but because the pressure has not been alleviated, neuroma pain may persist. I prefer surgical treatments that decrease pressure on the forefoot. Usually this is a procedure to lengthen a tight calf muscle alone or in combination with a procedure to change the bony anatomy of the forefoot. When non-operative treatments have failed, calf-lengthening procedures have been successful in treating “neuroma” pain in nearly 95% of patients. Calf-lengthening has even been successful in patients who have had previous neuroma surgery.
by Dr. Jeff Rocco – Orthopedic Surgeon | Specializing Foot and Ankle Reconstruction, and Lower Extremity Trauma