Neuroma pain is described as a burning pain in the forefoot. It can also be felt as an aching or shooting pain. Patients with this problem frequently say they feel as though they need to take off their shoes and rub their foot. This pain may occur in at any time. Commonly this involves the 3rd and 4th toes. Repeated trauma or compression of these nerves causes the nerves to swell and thicken causing a neuroma to develop.
Patients will often experience a clicking feeling “Mulder’s sign” in the forefoot followed by a sharp shooting pain or a sensation of numbness or pins and needles extending into ends of their toes. Tight, narrow fitting shoes may often exacerbate these feelings which become worse after long periods of standing or walking. Once the problem progresses, symptoms will become more frequent and often more intense. For athletes the pain occurs in the middle of a run or at the end of a long run.
The cause of the problem is patient specific. An accurate diagnosis must be made by means of a thorough history. The podiatrist will also gather further information about the cause through a hands on assessment where they will try to reproduce your symptoms. A biomechanical and gait analysis will also be performed to assess whether poor foot alignment and function has contributed to your neuroma.
Relief of symptoms can often start by having a good pair of well fitting shoes fitted to your feet, ensuring that the shoes don’t squeeze your foot together. Once footwear is addressed patients may require a small pre-metatarsal pad to be positioned onto the insole of the shoe to help lift and separate the bones in the forefoot to alleviate the pressure on the nerve. If the patients foot structure and mechanics is found to be a contributing cause, a custom made orthotic is usually the most convenient and effective way to manage the problem. Sometimes an injection of local anaesthetic and steroid is recommended to assist in settling acute symptoms.
If pain persists with conservative care, surgery may be an appropriate option. The common digitial nerve is cut and the neuroma removed. This will result is numbness along the inside of the toes affected.
About 70% of patients have success with conservative treatment.