Do you complain about pain on the ball of your foot or radiating numbness and tingling in your toes? You may be suffering from a neuroma. As a runner myself I have experienced this running injury and it is best to recognize and treat it as early as you can. We would like to discuss the basics of what a neuroma is, how you get it, as well as simple conservative treatment to resolve it and keep you running pain free.
A neuroma is a thickening of a nerve, and on the foot this occurs most frequently between the third and fourth metatarsal bones and toes. The nerve runs in between these areas can become inflamed when the metatarsal bones are compressed together such as may occur with tight fitting shoes. It may also be aggravated by overuse micro trauma that occurs in weight-bearing sports and exercise, and by biomechanical asymmetries such as over-pronation of the feet.
The symptoms of a neuroma can include pain on the ball of the foot that may be accompanied by a feeling of "pins and needles" or numbness to the 2nd, 3rd or 4th toes.
The initial treatment for a neuroma involves the correction of the causative factors. This can include changing to a wider toe box shoe as well as getting rid of worn out running shoes (more than 400 miles or older than 6 months). A removable metatarsal pad that offloads and takes pressure off the ball of the foot is very helpful to relieve symptoms. If this is still not effective we may recommend a series of injection (NO MORE THAN 3) to help reduce inflammation around the nerve. Alcohol sclerosing agent injections is another conservative treatment option that essentially quiets the nerve inflammation. Other conservative treatment may include the use of custom sports orthotic devices to control any biomechanical problems such as overpronation.
Finally, if aggressive conservative treatment does not resolve your symptoms, and the pain is causing a modification of your normal activities, surgery may be recommended to remove the inflamed nerve.
It is best if this foot injury is caught early and diagnosed correctly because other problems such as metatarsal stress fractures and metatarsal bursitis can sometimes mimic the symptoms of Morton's neuroma.