What is a Neuroma?

Common foot problems  •  Mon 14 Aug 2017

You may know the feeling: you have been on your feet all day and then out of the blue there's a stabbing pain like an electric shock in the ball of your foot.

Sometimes it feel like it shoots into your toes and sometimes up the top of your foot. 

Some shoes make it worse, some shoes can make it feel better. 

Sometimes it’s there and sometimes it’s not.  

So what causes this pain???

What is a Neuroma?

The front part of your foot is a rather complex piece of anatomy. 

With so many tendons, nerves, ligaments and bones confined to such a small space it’s no wonder it’s a part of the foot susceptible to injury and pain. 

Repetitive, abnormal loading in this area can cause damage to the nerves that pass between the joints where the toes meet the feet. 

Occasionally the nerve can become so irritated that it thickens. 

When stress continues to occur on this thickened nerve, it may produce an electric shock type pain into the toes and even up the top of the foot.

This thickened nerve is called a neuroma.

Neuromas tend to feel most uncomfortable when you wear tight fitting, narrow shoes with high heels. 

In this type of footwear, the shoe pressure squashes the forefoot region and causes the bones to compress the nerve causing further irritation.

 Also, the higher the heel, the more force that is applied to the forefoot area. 

Thongs, sandals and slip on shoes can also irritate a neuroma due to the clawing of your toes that occurs with these shoes. 

Certain biomechanical factors can also exacerbate neuroma pain.

For example, a lot of flexibility in the forefoot joints allow for more bony movement in gait and stance leading to increased nerve stress. 

Also, tightness in the muscles in the back of the leg with cause your body weight to move to the balls of your feet more quickly, loading the forefoot bones for longer than normal.

 Treatment for Your Neuroma

The best way to treat neuroma pain is to reduce the force that is compressing the nerve. 

I generally recommend the following treatment pathway when a client presents with a neuroma:

• Prescribe an appropriate shoe that reduces compression stress in the forefoot area
• Trial simple paddings to change to loading in the bones that apply stress on the neuroma
• Use prescription foot orthoses to alter the foot biomechanics and reduce stress on the nerve
• Apply manual therapies such as foot mobilisation to encourage more normal joint motion and shockwave therapy and dry needling to reduce tightness in the muscles that increase the load in the forefoot
• Cortisone injection may be required to settle the inflamed nerve
• Surgery is sometimes required to remove the neuroma if all other conservative treatments fail.

The pain associated with a neuroma can be debilitating, however, the majority of neuroma cases are easily settled with the right sort of conservative Podiatry care.

Very few cases end up requiring surgery.

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