Back in 1876, a man by the name of Dr. Morton described the first case of Neuroma. The condition involves a bump that usually forms between the third and fourth toe. Consequently, the condition was referred to as Morton’s Neuroma, but today is often just referred to as a Neuroma. Neuro means nerve in Latin. The field of neuro- logy means the study of nerves. And a neuro- logical disorder describes conditions relating to your nervous system. So, as the name suggests, Neuro-ma involves nerve tissues in the foot.
A neuroma occurs when the tissues lining the nerves leading to the toes thicken. The result of this thickening is the characteristic bump in between the toes. The bump usually causes pain, described as burning, tingling, or numbing, felt in the toes or ball of the foot. The tell-tale symptom for most sufferers of a neuroma is pain between the toes experienced when walking. Some describe the feeling as like having a pebble stuck in their shoe.
The exact cause of a neuroma is still unknown, however there are known conditions that can contribute to the development of a neuroma. In short, anything that causes increased pressure or damage to the nerve area could contribute to the development of a neuroma. For example, ever heard someone say “beauty is pain?” Well, in the case of neuromas this may be the case; women are more commonly affected than men, possibly because of all the fabulous heels and pointy toed shoes fiercely frolicked in. Footwear that squeezes toes together can lead to the development of a neuroma and likewise, high-heels over two inches should be avoided as they increase the pressure on the toes. Additional contributors to neuromas involve the structure of the foot. An abnormal structure like high-arches or flat feet creates instability and adds strain to the toe joints. Damage from trauma can also cause the nerve to become inflamed. And finally, continued activity that strains the nerves can cause or worsen a neuroma.
What can I do to find relief from my neuroma?
When in pain, most people with neuromas find relief by refraining from walking, removing uncomfortable shoes, and massaging the sore area. More supportive, roomier, shoes with padding could also help relieve undue pressure that may be aggravating the neuroma.
You should seek treatment if you suspect you have a neuroma. Untreated neuromas usually get worse. One of our Physician Partners of America podiatrists will help you know for sure whether you have a neuroma and work with you to put a clear treatment plan in place to help you get better. Treatment plans will depend on the severity of the neuroma. Simple cases may be prescribed a pair of protective shoes to allow for healing while more severe cases may require surgical removal of the growth. It is important to seek help early to avoid the neuroma developing into a case that may require surgical treatment.
What happens if I need surgery?
If your case has progressed to a point where other options provide little to no relief, your physician may suggest surgery as your best option. As an outpatient procedure, patients are able to have the surgery performed at one of our Physician Partners of America surgery centers. Your physician will discuss their surgical approach, cover the expected outcomes of the surgery, and discuss a post-operative medication plan to manage pain.
The procedure removes the swollen nerve. First, your anesthesiologist may provide either local or twilight anesthesia to make you comfortable. Then, your surgeon will make an incision in your foot, usually on the top along the neuroma but can vary depending on your case. The nerve is then identified and then removed. Lastly, your surgeon will close your incision and apply a bandage.
At your first post-operative visit, your surgeon will remove the dressing to inspect the wound and apply a new dressing. Any sutures will most likely be removed 10-14 days following the procedure. During recovery, patients are required to keep their foot dry to minimize infection, to limit their activities, and to keep the foot elevated as much as often as possible. After any sutures are removed, patients are able to clean their foot and try out a spacious, supportive shoe. It may take around three weeks before even wearing a shoe feels comfortable again.
The recovery period usually lasts around 3-4 weeks. At that time, you may be able to walk around and start to become comfortable in shoes. However, it may be 3-4 months before you are able to feel fully improved after the surgery.
What are the risk?
The risks are low for a neuroma removal, but as with any surgery, infection, extreme swelling, and longer healing than expected are always a risk. Having your procedure performed at our outpatient facility, however, lowers your chance of infection as compared with having the procedure performed at a hospital. Specific to this procedure is the small risk that the nerve may grow atypically after being cut. This abnormal growth may produce a stump neuroma. Finally, patients who walk on their foot despite instructions not to do so incur added risk; walking can cause swelling which may lead to bleeding or scarring. And this can result in prolonged pain and a longer window for recovery.