Neuromas

A neuroma is any irritating process of a digital nerve that supplies the bottom of adjacent toes.  The exact cause is unclear; however, an entrapment of the nerve with formation of scar tissue around the nerve is most likely.  It occurs in all age groups and is most prevalent among females.

Symptoms most commonly associated with a neuroma include pain, numbness, and burning.  It classically presents itself as a burning sensation “like walking on a hot pebble.”  Sometimes patients describe a cramping sensation in the arch, forefoot, or toes; however, there is no evidence of muscle cramping.  A characteristic sign is the overwhelming desire for removing the shoe, rubbing the forefoot, and flexing the toes.  This usually provides temporary relief of pain.

Spontaneous cure is unlikely and therapeutic intervention is usually required to resolve the discomfort.  The goal of treatment is to reduce symptoms so the patient can resume a normal activity level.  Non-surgical treatment includes modification of shoe gear, change in activity, orthoses, taping and padding, corticosteroid injections, physical therapy, and anti-inflammatory medications.

When the patient’s symptoms cannot be reduced to a tolerable level with conservative therapy, surgical intervention is indicated.  Neurectomy, removal of the neuroma, is the treatment of choice.  A small area is usually left without feeling, but this is preferable to pain.

After surgery patients are permitted to bear eight in a guarded fashion with a surgical shoe.  Stitches are removed at two weeks and an athletic shoe can be worn at three weeks postoperatively.  A gradual return to