You've been on your feet all day. The aching in the ball of your foot is getting worse. Finally, not being able to bare it any longer, you take off your shoe and massage your foot. It starts to feel better but, as soon as you put your shoe back on, the aching begins again. Does this scenario sound familiar? Then you may be suffering from Morton's neuroma.
A neuroma is a common foot ailment that affects many people on a daily basis. Those who suffer from neuromas find that as the day progresses the aching pain increases in intensity along with their activities. Removing their shoes and massaging the ball of their foot seems to be their only relief. With long standing symptoms, it often feels like they' re walking on a rolled up sock or pebble. They may experience shooting pains resembling that of electrical impulses traveling through their toes. Often this leads to a tingling sensation commonly described as "pins and needles." With time some may even experience numbness to their toes.
What is a neuroma and where does it come from?
As nerves pass through the foot they send branches in many different directions. When a nerve reaches the base of the toe, it divides, sending a branch to each side of two adjacent toes. Before dividing it passes between fairly large bones called metatarsals. There are five metatarsals, one for each toe. Their heads rest at the base of the toes. The metatarsals are very mobile and can impinge the nerve with every step a person takes. The nerve becomes compressed between continuously moving metatarsal heads. Every step causes greater pressure on the nerve. With time inflammation and irritation occurs. The repeated pressure and chronic inflammation causes thickening referred to as fibrosis and eventually scarring. At this point the neuroma symptoms only get worse. The metatarsals allow for very little space through which the nerve courses. As the irritated nerve becomes larger it takes less activity and pressure to aggravate it. So, the larger the neuroma gets, the worse the symptoms. Eventually the ball of the foot is painful with or without activity. The nerve no longer functions properly and consequently tingling, shooting pains and numbness result.
What can be done for neuromas?
Neuromas respond best to therapy when treated early in their onset, yet most people wait until the discomfort becomes intolerable before seeking help. By doing so, they decrease their chances of successful conservative treatment. At this point their pain is no longer a simple inflammatory process but a full blown neuroma with scarring and thickening of the nerve. If treated early, conservative therapy may consist of oral anti-inflammatory medication and modification of shoe gear with the use of a metatarsal raise. This device allows the metatarsals to spread away from the nerve as the foot steps down. Anti-inflammatory medication and a mechanical rest allow the inflamed nerve to quiet down, hopefully not to present again.
With the inflammation presenting, uninterrupted, the nerve becomes thick with organized scar tissue. Local cortisone injections are then required. Cortisone is capable of breaking apart scar tissue and acts as a potent local anti-inflammatory agent. Quite often this, combined with a metatarsal raise, can solve the problem. If pain persists, a series of cortisone injections may be required. The success of cortisone depends upon how scarred the nerve has become. The more scarring, the larger the neuroma and the less likely the success of the treatment.
Nerve alcohol sclerosing is proving to be very effective as another conservative approach. Basically the nerve ending is being killed with sequential alcohol injections. The end result is equivalent to that of surgical excision without the trauma of surgery. Numbness is usually associated in the area the working nerve once innervated.
After all conservative treatment has failed surgical excision of the neuroma is indicated. The surgical removal is usually successful with minor side effects such as numbness to the adjacent toes. These side effects are usually temporary but can be permanent. When asked, a person who has had a neuroma removed will probably tell you that having numbness to their toes is much better than the chronic pain. The surgical excision of a neuroma is performed on an outpatient basis and allows a patient to be walking with the use of a surgical shoe the same day the surgery is performed. Most people are wearing soft shoes by three to four weeks, although everybody is different and there are exceptions to the rule.
So, if you are experiencing aching, pressure, numbness, or shooting pains in the ball of your foot, you are probably suffering from a neuroma. The trick is to catch it early before its too late!
Jonathan Pattavina DPM of the
Advanced Foot and Ankle Specialists
practices in Keene and Peterborough, NH.