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Neuromas What are neuromas? How do the feet work? What are the symptoms of neuromas? What causes neuromas? How are neuromas diagnosed? What can be done to treat neuromas? What's involved in surgery for neuromas? What can I do to prevent neuromas from recurring? For additional information What are neuromas? A neuroma is a benign growth of nerve tissue along a nerve pathway. In terms of foot problems, it is a growth of nerve tissue that develops in the nerves that lead to the toes, causing pain, a burning feeling or numbness in the forefoot, often starting in the ball of the foot and radiating into the toes. Neuromas are often referred to as "pinched nerves" and "nerve tumors," although they are tumors only in that they are simply benign enlargements of nerve tissue and are not to be confused with cancerous tumors. Neuromas in the feet are also sometimes referred to as "Morton's neuroma," after the 19th Century Philadelphia surgeon who first described the problem. Neuromas most often develop in the nerve that serves the third and fourth toes, although it can affect other toes as well. It develops in response to problems that cause irritation or inflammation of the nerves, including trauma, biomechanical deformities and arthritis. The fact that neuromas occur eight times more frequently in women than in men suggests that a frequent cause is wearing tight shoes that squeeze the toes and high heels that shift the weight onto the front of the foot and jam the toes into too small a toe box. While neuromas often can be dealt with through conservative, medical treatments, surgical correction may be necessary in some instances. The surgical podiatrists of Hartford Specialists are both skilled and experienced in this area. (return to top) How do the feet work? Each of your feet has 26 bones, more than 30 muscles and numerous tendons, ligaments and nerves that work together to bear and propel your body weight during standing, walking and running. Bones provide support, ligaments provide stability and muscles and tendons provide movement. Nerves carry the electrical messages from your brain that control your muscle movements. The toes (as well as the fingers) are each made up of bones called phalanges, two in the big toes and three in the others. The bones at the ends are called the distal (meaning farthest away) phalanges, the ones in the middle (not present in the big toes) are called the middle phalanges, and the ones closest to the other bones of the feet are called the proximal (or nearest) phalanges. These join directly to the metatarsal bones, which lead to the bones that make up the ankles. The toes are controlled by the common digital nerves, which branch out of the medial and lateral plantar nerves. Neuromas most often develop where the nerve leading to the third and fourth toes passes beneath the ligament for the joint connecting those phalangeal bones to the metatarsal bones. (return to top) What are the symptoms of neuromas? Pain in the ball of the foot that radiates between the toes is the primary symptom of a neuroma, especially pain that comes while walking or wearing tight shoes. Often, this pain will wear off when you take off your shoes and perhaps massage your feet. It is uncommon to experience it when you have been off your feet, such as during or after a night of sleep. The pain may take the form of a burning pain in the ball of the foot, shooting pain toward the toes, tingling or numbness. (return to top) What causes neuromas? Neuromas develop in response to abnormal pressure or irritation that cause inflammation or swelling of nerve tissue. This can be a result of such issues as biomechanical problems in the motion of the feet, disease that may cause inflammation, or poorly-fitting shoes. The simple repetitive stress of a job that requires you to be on your feet all the time, such as waitressing, can lead to the development of neuromas. Biomechanical problems. Flat feet, or feet with high arches are susceptible to instability around the foot joints. If your muscles, tendons and ligaments don't work properly together, the stress on your toes may result in the inflammation of a neuroma. Poorly-fitting shoes. Tight shoes that squeeze your toes or high heels that shift your weight onto your toes are a major cause of all foot problems, including neuromas. The American Orthopaedic Foot and Ankle Society estimates that 88 percent of women in the United States wear shoes that are too small — and women experience neuromas eight times more often than men. Inflammation from disease. Diseases such as arthritis that may cause inflammation of the tissue surrounding the phalangeal joints can cause development of neuromas — as well as the physical stress of walking in a manner to compensate for the arthritic pain. Trauma. Injuries to a toe or toes can cause inflammation that leads to the development of a neuroma. (return to top) How are neuromas diagnosed? Your physician can diagnose your neuroma through a physical examination of your foot to see if the enlarged nerve tissue represented by the neuroma can be felt, perhaps placing pressure against your toes and the ball of your foot to try to replicate the pain. Other causes such as arthritis or stress fractures can be ruled out with range of motion tests and possibly x-rays. (return to top) What can be done to treat neuromas? Conservative — that is, nonsurgical — treatment measures should be tried first with the goal of correcting the irritations and resolving the symptoms. These include: Roomier shoes. You should seek out shoes that conform to the shape of your feet as much as possible and provide plenty of room in the toe box, ensuring that your toes are not pinched or squeezed. You should make sure that, while standing, there is a half inch of space for your longest toe at the end of each shoe. Make sure the ball of your foot fits comfortably in the widest part of the shoe. Feet normally swell during the course of the day, so shop for shoes at the end of the day, when your feet are at their largest. Don't be vain about your shoe size — sizes vary by brand, so concentrate on making certain your shoes are comfortable. Remember that your two feet are very likely to be different sizes so you should fit your shoe size to the larger foot. Low-heel shoes. High heels shift all your body weight onto the front of your foot and jam your toes into the front of your shoes, tremendously increasing the pressure on them and the joints associated with them. Instead, wear shoes with low (less than two inches) or flat heels that fit your foot comfortably. Padding. You can buy pads at most drug stores to wear inside your shoes to cushion your feet and areas of pain. Medications. Over-the-counter medications such as aspirin or ibuprofen can help reduce inflammation and pain. Nonsteroidal cortisone injections administered by your physician can help with this also. Orthotics. Orthotics are shoe inserts that can help correct mechanical foot-motion problems that cause pain and inflammation. (return to top) What's involved in surgery for neuromas? If your neuroma can't be dealt with successfully through conservative treatment, you may want to consider surgery. During neurectomy, the surgical procedure for removal of a neuroma, the surgeon may excise the inflamed or enlarged portion of the nerve, or possibly release tissue surrounding the nerve to relieve pressure on it. Neurectomy is most often done on an outpatient or day-surgery basis, usually with a local anesthetic technique called an ankle block. The surgery typically takes an hour or two to perform. You should keep in mind that any surgery carries with it very small-but-possible risks of complications such as allergic reaction to anesthesia, bleeding and infection. Recovery usually involves from a few weeks to 90 days. Before you leave the hospital, you will be given a special post-surgical shoe to wear to protect your foot. You may need to use a cane or crutches for the first several days and to be careful about putting weight on your foot. You should try to keep your foot elevated and treated with ice as directed for several days, and you will continue to need to utilize the bandages and shoe for several weeks. (return to top) What can I do to prevent neuromas from recurring? If you go back to the same habits in terms of shoes, you are likely to develop your neuromas again. To avoid them: Wear roomier shoes Seek out shoes that conform to the shape of your feet as much as possible and provide plenty of room in the toe box, ensuring that your toes are not pinched or squeezed. Make sure that, while standing, there is a half inch of space for your longest toe at the end of each shoe. Make sure the ball of your foot fits comfortably in the widest part of the shoe. Since feet normally swell during the course of the day, shop for shoes at the end of the day, when your feet are at their largest. Don't be vain about your shoe size — sizes vary by brand, so concentrate on making certain your shoes are comfortable. Remember that your two feet are very likely to be different sizes and fit your shoe size to the larger foot. Don't wear high-heel shoes Avoid high heels, which shift all your body weight onto your toes, increasing the pressure on your toes and their joints tremendously. Wear shoes with low (less than two inches) or flat heels that fit your foot comfortably. Wear orthotics to correct mechanical movement problems Orthotics are shoe inserts that can help correct mechanical foot-motion problems to reduce pain and prevent worsening of your neuroma. (return to top) For additional information You can find additional information about neuromas at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations. Likely sources include: The American College of Foot and Ankle Surgeons (www.acfas.org) The American Podiatric Medical Association (www.apma.org) The American Orthopaedic Foot and Ankle Society (www.aofas.org)

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