Footnotes / Blog

What Is Neuroma?

When a patient describes feeling like they have a “burning rock in their shoe,” it often signals the presence of a neuroma. A neuroma is an irritated, inflamed nerve, typically located in the ball of the foot, that can cause sharp, burning pain or numbness. Despite the alarming suffix “oma,” it is important to note that a neuroma is a benign (non-cancerous) condition and is usually treatable with conservative methods.

What Causes a Neuroma?

The human foot has five toes, each connected to a corresponding metatarsal bone. These metatarsals are the longest bones in the foot and play a critical role in transferring weight from the heel to the front of the foot during walking. The ends of the metatarsals, called the metatarsal heads, form the ball of the foot. The metatarsal heads are connected by a ligament known as the deep transverse metatarsal ligament.

Beneath this ligament, nerves run between each metatarsal head, providing sensation to the toes. Sometimes, these nerves can become entrapped between the metatarsals and the ligament, resulting in irritation and inflammation. This leads to the pain, which can feel like a burning sensation or shooting pain, often accompanied by numbness. The third interspace (between the third and fourth metatarsals) is the most commonly affected, followed by the second interspace.

Persistent irritation can lead to the formation of scar tissue and nerve bulging, which is why the term “neuroma” is used. Though the condition can be uncomfortable, it is non-cancerous and usually responds well to treatment.

Treatment Options

Neuromas are generally treated conservatively, with the goal of reducing inflammation and relieving symptoms.

1. Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are commonly prescribed to reduce inflammation and pain associated with neuromas. This can help provide immediate relief for some patients.
2. Ice Therapy: Applying ice to the affected area on a daily basis can help reduce inflammation and provide temporary pain relief. Cold compresses or ice packs should be applied for 15-20 minutes at a time.
3. Padding and Footwear Adjustments: Special padding or orthotics can be used to redistribute pressure on the foot and reduce irritation to the affected nerve. Additionally, wearing shoes with a wider toe box and avoiding high heels can alleviate pressure on the ball of the foot, providing relief.
4. Cortisone Injections: For more persistent pain, cortisone injections may be administered to reduce inflammation in the affected area. These injections can offer relief for several weeks or longer, though multiple injections may be necessary.
5. Surgical and Non-surgical Interventions: In cases where conservative treatments fail, imaging techniques like MRI or ultrasound may be used to assess the extent of the neuroma. Based on the findings, one of the following procedures may be recommended:
   • Surgical Excision: For larger neuromas, surgical excision may be necessary to remove the irritated nerve and alleviate symptoms.
   • Radiofrequency Ablation: For smaller neuromas, a minimally invasive procedure known as radiofrequency ablation can be used to heat and destroy the affected nerve, providing long-term relief.

Conclusion

Neuromas are a common cause of burning, sharp pain in the ball of the foot, often caused by entrapped nerves. While the condition can be uncomfortable, it is benign and usually responds to a variety of conservative treatments, such as anti-inflammatory medications, ice therapy, padding, and cortisone injections. In cases where symptoms persist, further diagnostic imaging may be needed, and surgical or minimally invasive procedures can be considered.