A neuroma is a benign tumor of a nerve and occurs most commonly between the third and fourth toes. It is caused by a pinching of the nerve between the metatarsals, which causes inflammation.
As this irritation continues, the nerve gets larger, forms a benign tumor (which is what a neuroma actually is) and causes sharp pain, cramping and burning.
Many times, the pain resembles a hot poker-type pain, knife-like, or electrical shock sensations. The symptoms may move into the web space or toward the tips of the toes. Pain is often noticed while driving or riding in a car.
Shoes that are too tight will aggravate the condition. Sometimes, temporary relief is experienced by removing the shoe and exercising the toes or rubbing the foot.
The condition is often related to an imbalance in walking. The neuroma may need to be surgically removed. Neuromas may also occur between any of the other toes of the foot, or on the inner aspect of the heel.
Conservative measures are generally tried before considering surgery. This usually consists of an injection of "cortisone-like" medication into the neuroma, followed by physical therapy. Occasionally, custom made arch supports are helpful.
Experience has taught us that if the pain has been present for more than 12 months, the neuroma generally will not respond to conservative treatment, and surgical excision will be required. However, we usually like to at least try an injection and therapy first, and most of the time we will know within three weeks whether surgery will be required.
The operation is done as Day Surgery. The incision is placed on the top of the foot (although the tumor is on bottom) to avoid a permanent scar on the bottom. The tumor is located and removed.
Stitches will remain in place for two weeks. Appropriate sterile dressings are used and walking is permitted beginning on the day of surgery in a special surgical shoe, although the amount of walking is limited.
The sharp, severe pain is relieved almost immediately after surgery. The operation is usually not very painful, and most people take one pain pill the first day, and one or two the second day, and then switch to plain Tylenol or Advil thereafter.
There will be some numbness between the affected toes on the bottom surface, but this is preferable to the pain associated with a Morton's Neuroma. A large portion of this numbness will dissipate over a period of a few months. You will notice it while rubbing your toes, but it will not affect the way you walk.
On some occasions, neuromas may return, but this is the exception rather than the rule. Most people begin wearing an athletic shoe or comfortable oxford as soon as the stitches are removed at two weeks. Dress shoes, heels, and pumps are discouraged for an additional two weeks.
DR. CHRIS ALBRITTON
2501 S. Willis
Abilene, TX 79605
325-695-8990