What are Neuromas?
Commonly called a Morton’s neuroma, this problem begins when the outer coating of a nerve in your foot thickens. This thickening is usually caused by irritation that results when two bones repeatedly rub together (often due to ill-fitting shoes or abnormal bone movement). The area between the third and fourth toes is the most commonly affected; the area between the second and third toes is another common irritation point. Nerve problems due to diabetes or alcoholism may also cause neuroma-like symptoms.

Symptoms
The pain from neuromas may start gradually, causing burning, tingling, cramping, or numbness. Symptoms often occur after you’ve been walking or standing for a period of time. It might feel like you’re stepping on a lamp cord. You may need to take your shoe off and rub your foot. In some cases, the pain radiates from the tip of the toes to the ankle.

Evaluation
To help diagnose your problem and determine the best treatment for your neuroma, your podiatrist looks at your medical history, thoroughly examines your foot, and performs any necessary tests.

Medical History and Physical Exam
Your podiatrist talks with you about your symp-toms, the frequency of your pain, and any past medical history that could involve nerve problems. Then your podiatrist examines your foot carefully, palpating (pressing) the areas around the neuroma to determine the extent of your pain.

Tests
X-rays may be used to help identify a possible neuroma, or to rule out other causes of the pain. Ultrasound, which uses sound waves to show internal soft tissue, may also be performed. Another diagnostic test, which can also relieve pain, involves blocking the nerve by injecting anesthesia around it. Occasionally, magnetic resonance imaging (MRI) may be done to reveal cross-sectional images of soft tissue and bone.

How Does My Podiatrist Treat Neuromas?
After your evaluation, your podiatrist will talk with you about the most appropriate care for your neuroma. Nonsurgical treatment methods may include orthotics, medications, ultrasound, or shoe adjustments.

Nonsurgical Care
Orthotics
Custom shoe inserts adjust the structural support of your foot, helping to prevent irritation to the nerve.

Medication
Cortisone injections or other medication can relieve pain and swelling in the nerve’s outer coating.

Ultrasound Therapy
Sound waves may help reduce swelling around the neuroma.

Shoe Changes
Pads can cushion and support the parts of your foot that are vulnerable. Roomy, supportive shoes can help prevent irritation.

Will I Need Surgery?
If nonsurgical care does not help, surgery may be necessary to remove the neuroma. A local anesthetic may be used for this procedure. The surgery may be done in your podiatrist’s office, a surgical center, or a hospital.

After Surgery
Following your surgery, you may feel numbness (possibly permanent) in the area where the nerve was removed. Your podiatrist will tell you how soon you can be on your feet. Usually, you can return to normal activities within three to six weeks.

What Can I Do About Neuromas?
Shoes can make all the difference. Be sure they’re supportive—and roomy enough for your toes to wiggle. Avoid certain movements, such as squat-ting and knee-bending, which can irritate the nerve. See your podiatrist if your symptoms continue or other foot problems arise.

Consultant: Brad L. Naylor, DPM, MS With contributions by: Stephen R. Doms, DPM, Lori J. Hillman, DPM and Richard O. Lundeen, DPM

This information is not intended as a substitute for professional health care.
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