neuroma schematic

Neuromas

A neuroma (also called a Morton's Neuroma, a "pinched nerve" or a nerve tumor) is a benign swelling of a nerve most often between the third and fourth toes, however can occur between any of the toes. Usually one will have a burning, tingling or numb sensation between the toes and in the ball of the foot, especially while walking. People often describe the pain either as having a stone in their shoe, or that their sock is bunched up beneath their toes.

Causes

The exact cause is uncertain, however a number of factors can contribute to the formation of a neuroma:

  • Foot deformities like having either a high arch or flat foot can lead to a neuroma, as these foot types tend to be more unstable.
  • Injury to the foot can damage the nerve and cause swelling of the nerve.
  • Shoes. Any shoe that squeezes the toes together can cause a problem. Heels taller that two inches tend to put more pressure on the ball of the foot where the nerve is located and can cause the nerve to become inflamed.
  • Repetitive stress to the foot, common in many occupations, can aggravate the nerve.

Diagnosis & Treatment

Diagnosis of a neuroma is typically based on the patient's symptoms and examination of the foot. Often, Dr. Sheff will perform an ultrasound exam as well which can visualize the inflamed nerve and help provide a prognosis based on the size of the inflamed nerve.

Treatment varies depending on how severe the pain is:

Shoe selection

Any shoe that pinches your toes together should be avoided and any shoe with a heel higher than two inches can be a problem, as each of these can cause irritation to the nerve.

Orthotics

Often a simple pad [called a metatarsal pad] can be worn in the shoe to help take pressure off the nerve and relieve the pain. Although this is often extremely effective, it will not cure the condition, but correct it and it is important to wear the orthotics as often as possible.

Medications

Anti-inflammatory drugs and cortisone injections can be used to ease acute pain, but these are only temporary and once their effects have worn off, the pain will quickly return. However, neuromas can be successfully treated with a series of dehydrated alcohol injections which basically "shrink" the nerve.

These injections are performed in the office under ultrasound guidance and given between two and three weeks apart. The benefit to injection therapy is the word cure can be used, as opposed to simply treating the symptoms.

Laser Therapy

The laser utilized in our office serves to increase the body's ability to heal. By exposing the inflamed nerve to a series of laser treatments, the body can bring down the inflammation of the nerve. The advantages of the use of the laser is the fact that it is 100% painless with absolutely no side effects. Often patients require 6-8 sessions of laser therapy with each session lasting seven minutes.

Surgery

When all else fails, surgical removal of the inflamed nerve will effectively cure the condition, however it is rare that one needs surgery given the success rates with injection therapy. Surgery is performed as an out patient basis at Newport Hospital.