The ball of your foot is the bottom part just behind your toes. Bands of tissue (ligaments) connect the bones in the ball of your foot. Nerves run between the bones and underneath the ligaments. When a nerve becomes pinched, this causes it to swell and become painful. The painful, swollen nerve is called a neuroma. A neuroma most often occurs at the base of either the third and fourth toes or the second and third toes.
Wearing tight or high-heeled shoes can cause a neuroma. Shoes that are too narrow or too pointed squeeze the bones in the ball of the foot. Shoes with high heels put extra pressure on the ends of the bones. When the bones are squeezed together, they pinch the nerve that runs between them.
The most common symptom of a neuroma is pain in the ball of the foot between two toes. The pain may be dull or sharp. It may feel as if you have a stone in your shoe. You may also have tingling or numbness in one or both of the toes. Symptoms may occur after you have been walking or standing for a while. Taking off your shoes and rubbing the ball of your foot may relieve the pain.
To prevent a future neuroma, buy shoes with plenty of room across the ball of the foot and in the toes. This keeps the bones from being squeezed together. Wearing low-heeled shoes also puts less pressure on the bones and nerves in the ball of the foot.
Online Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=233&topcategory=Foot
Online Source: The Physician and Sportsmedicine http://www.physsportsmed.com/issues/1997/05may/mollica.htm
The diagnosis of Neuromas is made by a physical exam and a thorough history of the patient’s complaint. Conditions that mimic the pain associated with Neuromas are stress fracture of the metatarsals, inflammation of the tendons in the bottom of the toes, arthritis of the joint between the metatarsal bone and the toe, or nerve compression or nerve damage further up on the foot, ankle, knee, hip, or back. X-rays are generally taken to rule out a possible stress fracture or arthritis. Because nerve tissue is not seen on an x-ray, the x-ray will not show the neuroma. A skilled foot specialist will be able to actually feel the neuroma on his exam of the foot. Special studies such as MRI, CT Scan, and nerve conduction studies have little value in the diagnosis of a neuroma. Additionally, these studies can be very expensive and generally the results do not alter the doctor’s treatment plan. If the doctor on exam cannot feel the neuroma, and if the patient’s symptoms are not what is commonly seen, then nerve compression at another level should be suspected. In this instance, one area to be examined is the ankle.
Just below the ankle bone on the inside of the ankle, a large nerve passes into the foot. At this level, the nerve can become inflamed. This condition is called Tarsal Tunnel Syndrome. Generally, there is not pain at this site of the inflamed nerve at the inside of the ankle. Pain may instead be experienced in the bottom of the foot or in the toes. This can be a difficult diagnosis to make in certain circumstances. Neuromas, however, occur more commonly than Tarsal Tunnel Syndrome.
Treatment for the neuroma consists of cortisone injections, orthotics, chemical destruction of the nerve, or surgery. Cortisone injections are generally used as an initial form of treatment. Cortisone is useful when injected around the nerve, because is can shrink the swelling of the nerve. This relieves the pressure on the nerve. Cortisone may provide relief for many months, but is often not a cure for the condition. The abnormal movements of the metatarsal bones continue to aggravate the condition over a period of time.
To address the abnormal movement of the metatarsal bones, a functional foot orthotic can be used. These devices are custom-made inserts for the shoes that correct abnormal function of the foot. The combination treatment of cortisone injections and orthotics can be a very successful form of treatment. If, however, there is significant damage to the nerve, then failure to this treatment can occur. When there is permanent nerve damage, the patient is left with three choices: live with the pain, chemical destruction of the nerve, or surgical removal or decompression of the nerve (see neuroma surgery).