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A few years ago, I started having a weird pain in the ball of my right foot. It didn’t hurt all the time, but sometimes when I put weight on it, it felt as if my foot was on fire. And other times, it was like I had a wad of cotton tucked in under my toes. An ultrasound showed that I had two Morton’s neuromas just below my third and fourth toes.
Dr. Michael Saradarian, a podiatrist at Central Maine Orthopaedics in Auburn, explains what neuromas are and how they can be treated.
Dr. Michael Saraydarian
The human body, although it is an amazing structure, is not designed perfectly in certain areas. Just like your ulnar nerve is exposed at your elbow and hurts when you hit it, the common branch in the foot slips underneath a ligament in the ball of your foot. It is a sensory nerve between toes two and three and four. In certain circumstances, the nerve gets irritated and effectively gets inflamed or bigger. When it’s bigger, it’s more prone to getting irritated and then it can get into a cycle and end up being a neuroma, also known as a perineural fibrosis.
I had one myself and it was a bit deal. I adjusted my shoe equipment, applied ice nightly, and made sure to stop the aggravating activity that I was doing. Unfortunately, that didn’t work. So I had to have a shot of cortisone which surrounded the nerve and shrunk it down. It worked and now I just have to be careful.
A neuroma is not something you usually get rid of. You have to be mindful of it and if you get into a situation that reinvites the symptoms, adjust for it. Periodically, I’ll do something and bring on a little twinge, but I’ll react to it and it’s fine.
The syptoms are very classic. People will say they feel like they’re walking on a marble. They could also get burning pain. The symptoms can be variable because it’s a nerve — so pain can be sharp, burning, or radiating.
Certain patients can’t break the neuroma cycle. After conservative care fails (which is usually substantial and involves a good degree of time and effort,) we’ll get an MRI to look at the nerve. We want to make sure it is, in fact, inflamed and visible and big enough.
If surgery is necessary, the current trend is to just make space for the nerve and that seems to work very effectively. The soft tissue envelope that is impinging on the nerve is released. Years ago they used to excise or take out the nerve but that was a lot less predictable and the local area of the foot would go numb.
Neuromas are among the most common things I see as a podiatrist, along with plantar fasciitis, bunions and arthritis.
What causes Morton’s neuroma?
The exact cause of a neuroma is unknown but there are several possibilities:
- Heels higher than 2-inches
- Narrow, tight-fitting or pointed-toe shoes
- Flat feet
- High arches
- Sports that involve running
- Pre-existing conditions such as bunions and hammer toes
For my neuroma, the conservative approach seems to work pretty well. I wear orthotics or inserts in certain shoes and boots and try to avoid tight-fitting and pointed-toe shoes. Otherwise, if my foot begins to hurt, like Dr. Saraydarian, I adjust accordingly.
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