Neuromas are generally described as a pinched nerve at the base of the toes.
Pain, numbness, burning and tingling are all terms patients use to describe what they are feeling in the ball of the foot, the toes or the general region. Radiating pain is often described as traveling out into the tips of two specific toes.
Patients usually describe pain as starting after a change in activity, new shoes, new exercise program or some large event. They often have discovered that going barefoot or wearing flimsy shoes exacerbates the pain. Athletes talk about the pain showing up after a specific amount of running or biking etc. Pain can come and go spontaneously but normally becomes a permanent fixture after enough irritation and damage to the nerve has occured.
The first line of attack is to decrease inflammation and injury to the nerve. This can be accomplished by wearing stiffer soled shoes combined with inserts or orthotics in the shoes that distribute pressure into the arch and away from the ball of the foot. The inserts can be augmented with felt/foam padding as needed.
Icing, resting, ibuprofen or other NSAIDS can be useful if used carefully and routinely.
Steroid injections can be very helpful in decreasing the inflammation around the nerve tissues, causing softening/atrophy of surrounding tissues etc. Many patients find that one or two injections helps relieve the pain for good or for over a year.
The next level of treatment is to damage the nerve enough that it no longer can send pain signals to the brain. Neurotherm, Coblation etc are options available and are normally procedures carried out in the operating room under local anesthesia using ultrasound to locate and either freeze otherwise damage the nerve. Success rates vary by Dr, but most report around 70% success rate.
If all else fails, then surgical removal of the nerve is the last option. Studies have shown that an aggressive approach with the nerve being resected as far back as possible will give the patient the longest and most pain relief period as possible with over 90% success rates. It is possible for the nerve to grow back or grow into a “stump neuroma” either of which may require repeat of the surgery, however this may take years to occur and is best prevented by tracing the nerve as deeply into the foot as safely and practically as possible.
Surgery has risks such as infection, hematoma, chronic pain and other complications. These complications are relatively rare and recovery from surgery usually involves 2-3 weeks of wearing a post op shoe and bandages until sutures are removed. Scar tissue and swelling can take several months after that to resolve to the point of being pain free.
We always suggest exhausting conservative options prior to surgical interventions are attempted.
Dan Preece, DPM
Dan Preece, DPM & Darren Groberg, DPM