A neuroma can occur anywhere in the body. It is simply an irritation/inflammation of a nerve, usually in an extremity and most commonly in the foot. The nerve that gets irritated is generally the interdigital nerve (between either the 2nd and 3rd toes, or the 3rd and 4th toes). This nerve originates in the spine and comes down the back of the leg, passes by the inside of the ankle and dives into the bottom of the foot, eventually splitting into numerous “digital” nerves that pass between the metatarsal heads. This is the location where the nerve gets compressed. There are many potential reasons why a nerve can get compressed. In the foot, it usually has to do with excess motion of the foot (i.e. – too much pronation) which leads to stretching of the nerve. Sometimes swelling can cause irritation to a nerve. The nerves in the feet can be extremely sensitive in some people – this can predispose one to develop neuromas.
A patient comes to the office with the following symptoms: severe dull or aching pain in the ball of the foot, occasional numbness or tingling into the toes, symptoms are worse in dress shoes and with any type of weightbearing activity. Occasionally the pain is so severe that shoes must be taken off and the foot rubbed. This usually helps for a short time. The pain may extend back into the foot and occasionally up the leg. It often starts as a mild tingling in the toes and over time progresses to moderate or severe pain in the ball of the foot. The symptoms tend to come and go over time. Sometimes the toes will spread and a mass may be felt in the ball of the foot.
The typical foot type that develops neuromas is a high arch, flexible, pronated foot type. The high arch foot tends to have increased pressure under the ball of the foot and the nerves have to stretch slightly more than they do in an average arch. Also, the flexible, pronated foot tends to create more irritation to the nerves as they get stretched when the foot pronates (arch collapses). Any high impact activity, particular running and aerobics can also lead to excess stress through the ball of the foot and may lead to neuroma symptoms.
Treatment – try yourself
If you’ve been overactive, try resting. Stop the activity you’ve been doing, rest your feet as much as possible and do so for a few weeks. When you start up your activity again, do so slowly and watch for recurrence of symptoms.
Try other forms of exercise. This treatment approach can work for any foot problem simply because you are taking stress off your feet to allow the inflammation to subside. Swimming or cycling are excellent substitutes.
Massage the painful area with ice. This may help reduce inflammation. Once or twice a day for 20 minutes can be helpful.
Stretch your achilles tendon. After you’ve been walking around with pain in the ball of the foot, you will most likely end up with a tight calf muscle (because you will use the calf muscle to redistribute pressure off the ball) In the long run, a tight calf muscle will lead to increased pronation and increased pressure under the ball of the foot which will make the neuroma worse. To stretch the calf muscle, lean against a wall, shoes off, toes pointed in and very gently lean into the wall until you feel a gentle pull on the calf muscle. Hold it for several minutes. Do the stretch midday and later in the day and after exercise. Never stretch by hanging the foot off a stair or pushing the ball of the foot against the wall. This will over stretch the calf muscle and cause further injury (although it may feel good at the time).
Wear shoes with good arch support and heel counter support. Running shoes, hikers and some walking shoes are excellent choices. You will probably have to spend over $100 to get a good quality shoe. Don’t shortchange yourself. Stay in supportive shoes as much as possible, especially walking around the house.
Avoid leather sole shoes with heels greater than 1/2″ or pointy toes.