A neuroma is a swelling or scarring of a small nerve that connects to two of your toes and provides sensation to these toes. The symptoms can come and go depending on activity, shoe style and even, weather. They consist of pain or numbness, usually affecting the 3rd and 4th toes at the third interspace. Any action that shifts the body weight onto the front of the foot, such as wearing high heels, climbing stairs and running, can make a neuroma worse. It is an injury to a nerve that occurs slowly, over a long period of time.

SYMPTOMS

Neuromas frequently start as a numbness or tenderness in the ball of the foot. This is the area just behind the base of the toes. As the swelling increases, shooting pain and strange sensations such as numbness, burning and tingling in the area can radiate out into the toes or back into the foot. The area may be hot or very swollen and, just as mysteriously, the symptoms can disappear and reappear. At first, the pain is only present when weight bearing in tight shoes. As it gets worse, spontaneous shooting pains, often like electric shocks, can be felt even when you're off your feet.

ETIOLOGY

To understand why neuromas develop, it is important to know how the nerves connect to the toes. The nerve that carries sensation signals back from the toes starts in the midfoot between the metatarsals. The nerve passes beneath a strong ligament, or soft-tissue band, that holds the metatarsal heads together. Just after it passes this band, it splits in half forming a Y. Each half then connects to the adjacent sides of the two toes.

The neuroma usually develops just under or beyond the tight ligament. The constant pulling of nerve over the ligament irritates the nerve and causes the nerve to thicken and scar. The nerve also can get pinched between the two metatarsal bones that it passes between. A scarred nerve doesn't carry signals well and may send back strange signals to the brain such as burning, pain and tingling. So, instead of beautiful music, we get terrible noise.

Anything that stretches and pulls the nerve will aggravate the condition. For instance, wearing high heels aggravates neuromas in three ways. First, the higher heel will push the toes up from the rest of the foot and cause the nerve to tighten and pull harder against the tight ligament. Second, the tight toe box squeezes the front of the foot together leaving less space between the metatarsal bones for the nerve to rest. Finally, the body weight is put more on the ball of the foot increasing the pressure on the nerve. All 3 are bad news for you and your neuroma.

TREATMENT

After the diagnosis is made, the doctor may apply special padding to the foot to take the pressure off the area. An injection of an anti-inflammatory medicine (cortisone) mixed with numbing medicine (xylocaine) may be put into the area surrounding the nerve to calm it down. The doctor may also prescribe a prescription anti-inflammatory medication.

If these treatments are not effective at calming the neuroma down, orthotics may be prescribed to help control the abnormal mechanical structure of your foot. By preventing the arch from dropping, the nerve will not be stretched as much.

Finally, if these more conservative treatments don't work, then the faulty nerve may need to be removed. This is only a sensory nerve that doesn't control any muscles and only provides sensation to a small area between the toes. The nerve is removed through an incision in the top or bottom of the affected area. The nerve is identified and snipped just behind the swollen part and just beyond where it splits in two. Frequently, the tight ligament between the metatarsal bones is also cut to allow more room. It is a relatively minor procedure.