Neuromas

What Is a Neuroma?

A neuroma — most commonly Morton's neuroma — is a benign thickening of nerve tissue that typically develops between the third and fourth toes. As the nerve is compressed and irritated over time, it enlarges and becomes inflamed, causing significant discomfort in the ball of the foot.

Despite the discomfort neuromas cause, they are not tumors and are not dangerous. With proper treatment, the vast majority of patients achieve excellent relief without surgery.

Causes and Risk Factors

• Abnormal foot mechanics — flat feet, high arches, or bunions that alter the way weight is distributed across the forefoot
• Footwear — high heels and narrow, pointed toe boxes compress the metatarsal bones together, pinching the nerve between them
• Repetitive stress — activities that involve running, jumping, or sustained pressure on the ball of the foot
• Prior injury — trauma to the foot can trigger nerve irritation
• Tight footwear — any shoe that puts prolonged pressure on the forefoot

Symptoms

Neuroma symptoms are distinctive and tend to worsen with narrow footwear or prolonged activity:

• A burning, sharp, or shooting pain in the ball of the foot — often described as stepping on a pebble or a marble
• Numbness, tingling, or a pins-and-needles sensation between the third and fourth toes
• Pain that worsens when wearing narrow or high-heeled shoes
• Relief when you take off your shoes and massage the foot
• A clicking or popping sensation with each step (in some cases)

Diagnosis

Dr. Ross will palpate the forefoot to reproduce the characteristic click (Mulder's sign) and assess the exact location of nerve involvement. X-rays rule out bony causes of pain. Ultrasound or MRI may be used to confirm the diagnosis and measure the size of the neuroma.

Treatment

Conservative Treatment

• Footwear modification — the single most important change is switching to shoes with a wide toe box and low heel, immediately reducing compression of the nerve
• Metatarsal pads — strategically placed pads redistribute weight away from the inflamed nerve
• Custom orthotics — correct underlying mechanical abnormalities and offload the affected area
• Corticosteroid injections — reduce inflammation around the nerve and provide significant relief in many patients
• Sclerosing alcohol injections — a series of injections that gradually shrink the nerve tissue; an effective non-surgical alternative for some patients
• Physical therapy and icing — reduce inflammation and improve foot strength

Surgical Treatment

When conservative measures fail after several months, surgical removal of the neuroma (neurectomy) is a reliable and effective option. The procedure is typically performed as an outpatient surgery, and most patients return to normal activities within a few weeks. Dr. Ross will discuss the procedure and expected recovery in full detail before any decision is made.