Neuroma
A neuroma is one of the most common causes of pain in the ball of the foot.
A neuroma is a swelling which develops on a nerve. Most commonly this occurs between the third and fourth toes but can also occur between the second and third toes.
Typically there is pain in the ball of the foot. This is often described as “burning”. Often the pain radiates into the toes. The pain may be episodic. It may feel like a stone under the foot and sometimes there is a sharp “snap” felt as the neuroma clicks between the bones.
Examination usually reveals tenderness in the web space between the affected toes. Your Doctor will squeeze the foot from side to side to see if they can elicit a “snap” as this is virtually diagnostic. Often there will be decreased sensation over the affected toes.
Neuromas do not show on plain x-rays. They can be detected with special scans such as ultrasound.
Shoe wear
A wide soft shoe will be helpful. Sometimes a pad designed to take pressure off the area and spread the metatarsal bones will improve the situation.
Cortisone injection
An injection of local anaesthetic and cortisone can be very useful. If the local anaesthetic temporarily abolishes pain then this tends to confirm the diagnosis. At the same time the cortisone may reduce swelling and give a longer lasting relief. The response to cortisone is very individual. The maximum number of injections your Doctor will give is 3 separated by at least 4 weeks between each.
Surgery
If the above measures fail, then surgical resection of the neuroma is indicated. Most reports indicated 85% success rate after surgery. This still leaves a number with residual pain. Often this is due to regrowth at the cut end of the nerve (a “stump neuroma”). This occasionally can require further surgery.
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