A neuroma is a nerve that is inflamed, thickened or pinched in the ball of your foot. Neuromas are benign tumors and are usually not cancerous. This most commonly occurs when your toes are squeezed together too often and for a long period of time. As a result, the nerve that runs between the base of your toes and in the interspaces can swell and get thicker. It is also common for adjacent structures to the nerve to become thicker as well and cause a bursitis may develop. As time goes on and as the nerve becomes chronically irritated localized swelling around the nerve as well can make it painful when you walk on that foot. Many people will describe the neuroma as if you are standing on a pebble in your shoe or that their sock is bunched up. Some other commonly described symptoms of nerve pain are throbbing, burning, tingling, sharp, shooting, numbing and radiating pain.
Neuromas can also occur due to use of high heeled shoes and or shoes with a narrow and tight toe box. The incidence of neuromas are eight to ten times greater in women than men. The highest percentage of patients that do have a neuroma are found in women ages forty five to fifty. Simply limiting use of these shoes or changing to a wider and low heeled shoe can improve symptoms significantly. Fat pad atrophy, as people age, also makes patients more susceptible to developing neuromas. Walking barefoot, in old worn out shoes, in thin and flat flip flops and non cushioned ballerina flats can also encourage formation. Depending on body type, activity and fitness level, some minimalist sneakers may not offer enough cushioning and support as well. Your doctor at City Podiatry can make some appropriate individualized shoe recommendations for you.
Neuromas can occur between any two toes and interspaces but it is most common to occur between the third and fourth toes. This particular neuroma is called a Morton’s Neuroma. Lesser common areas are between the base of the second and third toes and the least common neuroma lies between the base of the the first and second, and fourth and fifth toes and interspaces. Your doctor will take xrays to rule out any bony pathology and also to access the structure of your feet. In most people with neuromas their intermetatarsal spaces are uneven. This creates a tight space and an environment where the nerve is susceptible to becoming inflamed.
Some clinical sign of this condition is when the two adjacent toes start to splay or spread away from each other. This is caused by unusually large space occupying neuromas that force the two toes to spread apart. Neuromas are typically painful but they may present in different ways. The sensation of walking on a marble, wrinkle in your socks and the burning pain in the ball of your foot may force you to compensate as you walk. Compensation can then lead to tendonitis and bursitis in the surrounding tissues.