A few weeks ago, I was in the Hamptons for a friend’s wedding. Wanting to take advantage of some downtime and the sunny weather, a couple of friends and I decided to go for a run on the beach. It was picture perfect: the breeze, the sound of the gulls, the cool water as we ran along the shoreline and then BAM! A jolt of electricity ran through my foot. This was something that I’d never felt before. Where did that come from? I was so caught off guard I had to stop to ensure I had not step on something. Despite the advice I tell all of my patient in these situations, I decided to press on and ignore the lightning storm happening in my foot. A few days later I realized that I needed to get honest. I’ve seen this thing a thousand times but never known what it felt like until now. This thing, was a neuroma.
So, let’s talk about neuromas. What is it and what causes it? A neuroma is a thickening of the nerve tissue. While there are many different types of neuromas located in different parts of the foot, the most common neuroma that we deal with here our practice (and the one that was causing me so much pain) is called a Morton’s Neuroma. This type of neuroma is found between the third and fourth metatarsals (see the picture to the right) and is usually a result of irritation or repetitive compression of the nerve. Our nerves are lined with a sensitive outer layer that responds to repetitive pressure or compression by building a protective “layer” around the nerve. In my case, and with many patients I see, it was a combination of repetitive irritation to the ball of the foot from being a long-time runner coupled with a flexible flatfoot, and an affinity for a narrower type of shoe that probably did me in. Yep, wearing shoes with a narrow toe box such as high heels, flats, and certain men’s dress shoes force the toes and metatarsals to bunch up together, causing friction or compression of the intermetatarsal nerves. These are not the only triggers for neuromas; people with bunions, hammertoes, flexible feet, or flatfeet are at higher risk for developing a neuroma as well.
Let’s go over a more comprehensive list of symptoms of neuroma pain. Nerve injury or pain is notoriously described as tingling, electricity, burning or numbness that may radiate to the toes or up the foot. Some people say they are sure a pebble is in their shoe or something is stuck on the bottom of the their shoe, only to find nothing. The symptoms usually progress over time, often beginning with a tingling or burning sensation in the ball of the foot. In truth, a neuroma can cause almost any physical sensation that a nerve can cause. That’s because a neuroma is a nerve that’s gone haywire.
If you think you have a neuroma it’s best to make an appointment in the early stages of the symptoms. If a neuroma is diagnosed early, we can develop a treatment plan that is tailored to your unique situation and the resolution of your symptoms is often much quicker. Many times, neuromas can be treated conservatively with: padding/orthotic devices, icing, temporarily modifying shoe gear and activities that cause abnormal amounts of pressure on the forefoot, certain oral or topical medications, and lastly, injection therapy. For more information, give us a call!