A neuroma is an enlargement, scarring, or general irritation of a nerve located between toes near the ball of the foot. It is most frequently found between the 3rd and 4th toes, but can present between any of the toes. The neuroma is typically caused by tight, narrow shoes which squeeze the toes together (and the neuroma develops over time). It can also be caused by a traumatic injury or may be hereditary. Neuromas are often seen in Athletes, especially runners as they tend to hit the ball of their foot repetitively during exercise. However, a neuroma can present in just about anyone. Symptoms can range from a dull constant ache to a sharp shooting pain, often radiating into the distal toes. Usually, there is a degree of pinpoint pain which may radiate out to the rest of the ball of the foot. Also, neuromas typically worsen with a tighter fitting shoe and high impact activities.
Treatment is almost always conservative, including injections and offloading orthotic devices. We typically offer an initial cortisone injection to see if the issue improves. If the pain lessens, then we offer an alcohol sclerosing injection series (1 injection every 2 weeks). While this may not sound like fun, the alcohol injections aim to shrink and eliminate the problematic nerve, which usually is enough to virtually get rid of the pain altogether. In turn, there is typically no need for any surgical intervention. However, If these conservative treatments do not relieve the symptoms, surgical excision may be performed.
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