A neuroma is the swelling of nerve that is a result of a compression or trauma. The pain can be described as burning, tingling or cramping with occasional shooting and numbness in the toes.
Symptoms usually occur during or after walking or standing. The most common site for a neuroma is on the ball of the foot. The most common cause of neuroma in ball of the foot is the abnormal movement of the long bones behind the toes called metatarsal bones. A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a "Y" and enter the toes. It is in this area the nerve gets pinched and swells, forming the neuroma. As the nerve swells, it can be felt as a popping sensation when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve. When the neuroma is present in the space between the third and fourth toes, it is called a Morton's Neuroma. This is the most common area for a neuroma to form. Another common area is between the second and third toes. Neuromas can occur in one or both of these areas and in one or both feet at the same time. Neuromas are very rare in the spaces between the big toe and second toe, and between the fourth and fifth toes. Neuromas have been identified in the heel area, resulting in heel pain.
A puncture wound or laceration that injures a nerve can cause a neuroma. These are called traumatic Neuromas. Neuromas can also result following a surgery that may result in the cutting of a nerve.
The diagnosis of Neuromas is made by a physical exam and a thorough history of the patient's complaint. The doctor will squeeze your foot while pushing on the neuroma. He is testing for a "clicking" feeling as he is doing this. This "click" usually represents a thickened nerve passing between the long bones of your foot. During this test you may experience a similar tenderness to the pain you feel when walking or standing.
Often with chronic neuroma formation, the toes will spread creating a "peace sign". This is referred to as Sullivan's sign and is due to the growing mass pressing on bone and soft tissue.
Conditions that mimic the pain associated with Neuromas are stress fracture of the metatarsals, inflammation of the tendons in the bottom of the toes, arthritis of the joint between the metatarsal bone and the toe, or nerve compression or nerve damage further up on the foot, ankle, knee, hip, or back. X-rays are generally taken to rule out a possible stress fracture or arthritis. Because nerve tissue is not seen on an x-ray, the x-ray will not show the neuroma.
Treatment for the neuroma consists of shoe changes, cortisone injections, orthotics, chemical destruction of the nerve, or surgery. Cortisone injections are generally used as an initial form of treatment. Cortisone is useful when injected around the nerve, because it can shrink the swelling of the nerve. This relieves the pressure on the nerve. Up to three cortisone injections can be given over a twelve-month period. Cortisone may provide relief for many months, but is often not a cure for the condition. The abnormal movements of the metatarsal bones continue to aggravate the condition over a period of time.
A new procedure is now available at the Feet For Life Centers called Nerve Decompression. Dr. Horwitz has successfully performed this in-office procedure without the use of endoscopy equipment on many patients. In fact, it has almost completely replaced the conventional neuroma surgery within the practice. The technique is very simple to perform with an over 95% success rate.
The procedure is performed through a tiny incision that requires only one stitch. Because the procedure involves the release of a ligament that puts pressure on the nerve, the nerve itself does not have to be removed. The consequences of cutting this ligament are very minor. The patient should not notice any change in the function or appearance of the foot, only relief of the pain.
The procedure is performed under local anesthesia. Sutures are removed in 2-5 days. Patients are able to resume normal activities very quickly and will be back in regular shoes in 1-3 days.
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