Understanding Neuromas in the Foot: Causes, Types & Symptoms

What Is a Neuroma?

A neuroma is a thickening of the nerve tissue that develops in response to irritation, pressure, or injury. In the foot, neuromas most commonly form in the ball of the foot between the toes, and the most frequently diagnosed type is Morton's neuroma.

Morton's neuroma develops on the nerve that runs between the third and fourth toes, though it can also occur between the second and third toes. The nerve tissue becomes irritated and inflamed, eventually thickening into a benign but painful mass. While it is not a tumor and does not spread, an untreated Morton's neuroma typically worsens over time as the nerve sustains ongoing compression.

Causes & Risk Factors

Neuromas develop when a nerve in the foot is subjected to repeated pressure, compression, or irritation. Common contributing factors include:

• Wearing tight, narrow, or high-heeled footwear that compresses the forefoot
• High-impact activities like running, tennis, or other sports that put repetitive stress on the ball of the foot
• Flat feet, high arches, or an unstable foot structure that alters the distribution of pressure
• Bunions, hammertoes, or other toe deformities that crowd the forefoot
• Foot injuries or trauma to the nerve

Women are diagnosed with Morton's neuroma more frequently than men, largely due to the prevalence of narrow and high-heeled footwear.

Symptoms

Neuroma symptoms are centered in the ball of the foot and may include:

• A sharp, burning, or shooting pain between the toes or in the forefoot
• A feeling of numbness or tingling in the toes, typically the third and fourth
• The sensation of standing on a pebble or a fold in your sock
• Pain that worsens when walking, standing for long periods, or wearing tight shoes
• Temporary relief when removing shoes and massaging the foot

Symptoms often come and go at first, improving with rest and worsening with activity. Over time, without treatment, the pain typically becomes more frequent and more intense.

Diagnosis

Dr. Barnes diagnoses neuromas through a physical examination of the foot, applying pressure to the forefoot to identify the location of the nerve and reproduce symptoms. Diagnostic ultrasound is a particularly useful tool for evaluating neuromas, as it can visualize the thickened nerve tissue in real time and confirm the diagnosis. Digital X-rays may also be taken to rule out other structural causes of forefoot pain, such as stress fractures or joint problems.

Neuroma Treatment Options Available at Our Council Bluffs Office

How Dr. Barnes Treats Neuromas

Treatment for a neuroma typically begins with conservative measures and progresses to more involved options if pain persists. The goal is to relieve pressure on the affected nerve and reduce inflammation.

Conservative Care Options

Many patients with Morton's neuroma experience significant improvement with non-surgical care:

• Footwear modifications: Switching to shoes with a wide toe box and low heel takes pressure off the forefoot and gives the nerve room to decompress. This is often one of the most impactful changes a patient can make.
• Padding and Metatarsal Support: Metatarsal pads placed inside the shoe help redistribute pressure away from the neuroma, reducing irritation with each step.
• Orthotics: Orthotic devices prescribed by Dr. Barnes can correct underlying foot mechanics that contribute to nerve compression and provide more consistent relief than over-the-counter insoles.
• Activity Modifications: Reducing high-impact activities temporarily gives the nerve a chance to settle down and begin healing.
• Anti-inflammatory Medications: Over-the-counter NSAIDs can help manage pain and reduce inflammation during flare-ups.
• Corticosteroid Injections: When other conservative measures aren't providing adequate relief, a precisely placed corticosteroid injection can significantly reduce nerve inflammation and pain. Some patients experience lasting relief from a single injection; others may benefit from a short series.

Surgical Treatment

When conservative care has been tried consistently and symptoms have not improved adequately, surgical removal of the neuroma is an effective option. Dr. Barnes performs neuroma excision by making a small incision on the top of the foot over the base of the affected toes. The enlarged nerve tissue is carefully removed through this incision. The procedure is typically performed in a surgical facility and takes approximately 15 to 20 minutes.

Following surgery, patients wear a surgical shoe during the initial healing period. Most patients transition to a lace-up shoe within two to four weeks and return to regular activities as healing progresses. Some patients experience a temporary bruised sensation on the bottom of the foot under the surgical site, which gradually resolves over several weeks. By eight weeks, most of the healing is complete, and patients are returning to their normal routines.