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Footnotes / Blog

Monday, August 30th, 2010 Kenneth Donovan

“it feel’s like i have a burning rock in my shoe”

I hear that from a patient i think instant neuroma. A neuroma is a inflamed, irritated nerve that causes pain in the ball of the foot. Hearing the suffix “oma” usually freaks people out, but in this case its a 100% benign condition and nothing to worry about.

So what causes this condition. In the human foot there is 5 toes. Each toe is connected to 5 metatarsal bones. The metatarsal bones are the longest bones of the foot, and help transfer the weight from the hindfoot to forefoot during normal gait. Anatomically the distal ends of the metatarsal bones are known as the “metatarsal heads”, which forms the ball of the foot you see as you look at the bottom of your foot. The metatarsal heads are rounded portions of the ends of the metatarsal bones that connect to the toes forming the metatarsal phalangeal joint (ie MTPJ). From left to right, each metatarsal heads is connected to each other by a ligament called the deep transverse metatarsal ligament. Under this ligament, in between each metatarsal, runs a nerve that supplies sensation to it’s corresponding interspace. This nerve sometimes becomes entrapped between the two metatarsal heads and ligament becoming irritated and inflamed, resulting in shooting, burning pain and sometime numbness. The 3rd interspace is the most common followed by the 2nd interspace. This persistent irritation can cause scar tissue and bulging of the affected nerve, creating the term “neuroma” we use today.

Treatment is pretty straight forward for this condition. It includes a round of anti-inflammatory medications, ice to the foot daily, paddings, and a cortisone injections to the affected area. The above helps to reduce inflammation, thereby providing symptomatic relief. In some cases the pain doesn’t subside (or returns) and which case a MRI or Ultrasound is performed. Once the extent of the pathology is ascertained, surgical excision (for large ones) or radiofrequency ablation (for small ones) is performed to remove the neuroma.

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