Neuroma

Neuroma is a pathologic condition based on the processes of benign overgrowth of the nerve sheath. The mechanism of development is associated with repeated microtrauma or constant pressure on the nerve, causing its chronic irritation. Over time, this leads to overgrowth of connective tissue around the nerve, and it's thickening. As a result of this process, the nerve becomes compressed between bony structures or ligaments, which is manifested by a number of unpleasant, painful symptoms.

Types of Neuromas

There are several types of neuromas (traumatic, neurinoma, and neurofibroma) among the most common are Morton's neuroma and interfinger neuroma.

• Morton's neuroma is the most common type of foot neuroma that occurs between the third and fourth toes. Nerve thickening develops due to constant pressure or irritation, which is often associated with wearing uncomfortable shoes, high heels, or gait patterns. This type of neuroma leads to overgrowth of tissue around the nerve and squeezing it, causing discomfort and pain when walking.
• Intertarsal neuroma is a type of neuroma that develops between any toes of the foot. It is more common between the third and fourth toes, although it can develop in other interfinger spaces. The mechanism of formation is similar to Morton's neuroma - chronic pressure and microtrauma provoke irritation and thickening of the nerve.

Both of these types of neuromas have similar processes of formation, but are localized in different interfinger areas.

Causes of Neuroma

Causes of neuroma development can be caused by a number of factors that put pressure on the nerves of the foot.

The main causes of neuroma are the following:

• Wearing uncomfortable shoes: shoes with a narrow toe or high heels put excessive pressure on the front of the foot and compress the nerves, causing irritation and possible thickening.
• Repetitive stresses on the foot: running, jumping, long walks contribute to the development of neuroma. Sports activities that require significant stress on the feet can cause microtrauma to the nerve, leading to its thickening.
• Genetic factor: hereditary peculiarity of the structure of the foot - high arch, flat feet or joint instability increase the risk of irritation and traumatization of the nerves.

Other factors that create conditions for nerve compression and irritation include:

• foot injuries;
• inflammatory processes in the joints;
• arthritis or bunions of the foot;
• overweight, which increases the load on the feet.

Symptoms and Signs

A neuroma presents with a number of characteristic symptoms that most commonly occur in the forefoot area. They are as follows:

• Pain between the toes: sharp, burning or aching. It intensifies with load on the foot (when walking or standing for a long time).
• Burning sensation in the area of the affected nerve: spreads to the toes and causes discomfort, especially when wearing tight shoes.
• Tingling sensation: tingling or numbness in the toes is associated with irritation and compression of the nerve, which causes sensory disturbances in the affected area.
• Sensation of a foreign body: the feeling of the presence of a “pebble” in the shoe is especially pronounced when walking and causes significant discomfort.

Neuroma is not only pain and discomfort; it is a significant decrease in daily activity and problems with mobility. If such signs appear, it is necessary to consult a specialist for accurate diagnosis and appropriate treatment.

Diagnostics: Understanding the Condition

Various diagnostic methods are used to confirm neuroma and rule out other possible causes of foot pain.

The main methods are:

• Physical examination: careful examination of the foot, palpation of painful points and checking sensitivity and muscle strength.
• Orthopedic tests: conducting special tests (Tinel’s test or Muller's maneuver) that help to detect nerve impingement.
• Ultrasonography (ultrasound): allows visualization of the soft tissues of the foot and detection of nerve thickening.
• Magnetic Resonance Imaging (MRI): provides a more accurate picture of the soft tissues of the foot and allows you to accurately determine the size and localization of the neuroma.

These diagnostic methods, combined with the clinical picture, help the doctor to accurately determine the presence of a neuroma and develop the most effective treatment plan.

Treatment Options for Neuroma

Treatment of neuroma can include various methods. The choice depends on the severity of symptoms and the progression of the disease.

Conservative treatment

• Orthotic insoles: help to redistribute the load on the foot - reduce pressure on the affected nerve. Supporting the arch of the foot with insoles and correcting the position of the toes, significantly reduce the severity of symptoms and prevent the development of neuroma.
• Drug therapy: prescription of non-steroidal anti-inflammatory drugs. The use of local anesthetics (ointments or creams).
• Injections: anesthetics or corticosteroids are effective for more severe symptoms. They help reduce inflammation and temporarily relieve pain. 
• Physical therapy: ultrasound, massage or special foot exercises can improve circulation in the foot, relieve muscle tension and reduce pressure on the nerve.

Surgical treatment

If conservative methods fail, surgical treatment methods are used.

• Neurectomy: removal of the affected area of the nerve. The surgery is performed through a small incision in the foot. After removal of the neuroma, symptoms usually disappear, but there is a risk of developing numbness in the toe area.
• Nerve decompression: a less invasive procedure - removing or pushing apart the ligaments and tissues compressing the nerve. This reduces the pressure on it and reduces symptoms without removing the nerve itself.

At Illinois Foot & Ankle Clinic, under the guidance of leading specialist, podiatric surgeon Dr. Alex Yanovskiy, DPM, a comprehensive diagnosis and individualized selection of neuroma treatment methods are performed in each case. Illinois Foot & Ankle Clinic helped many patients return to an active and pain-free life.