Numbness & Tingling In My Toes...

...What can I do for my Neuromas?

To understand what neuromas are, what causes them, treatment options and long-term prognosis, you need to start with a quick definition of a nerve. 

According to Merriam-Webster, a nerve is "any of the filamentous bands of nervous tissue that connect parts of the nervous system with the other organs, conduct nerve impulses, and are made up of axons and dendrites together with protective and supportive structures."

The nerves we are referencing for neuromas are small, string-like structures that provide sensation and/or give the signal to muscles to move.

So, What Are Neuromas?

Some nerves in the foot & ankle may be susceptible to injury because of their location. The most commonly injured nerves here are on the ball of the foot, located at the base of the second, third and fourth toes. These nerves provide sensation only to the middle three toes and may be compressed by a ligament that runs over it. A neuroma is when something, like inflamed tissue or other object in the body, presses on the nerve, causing irritation.

Signs & Symptoms of Neuromas

• Pain on the ball of the foot.
• Numbness, or a burning/shooting/tingling sensation in the toes. Either or both of these may be present.
• Cramping in the toes
• Aggravation by activities like running, aerobics or activities that put stress on the ball of the foot.
• Lessening of pain when removing the shoe and rubbing the affected area.
• Aggravation of pain in the ball of the foot from driving, by high heels or by walking barefoot.
• Numbness in the foot while active; for example, while on a treadmill or elliptical, doing lunges or Zumba-style classes.

Causes of Neuromas

Difference between an unaffected nerve
and a Neuroma, from
SouthFloridaSportsMedicine.com/neuroma.html

• Compression of the nerve against a tight ligament that connects the metatarsals.
• Arthritis or bone spurs in the adjacent joints.
• Soft tissue cysts causing nerve compression.
• Trauma to the ball of the foot.
• Nerve irritation from tight shoes; excessive barefoot walking on hard floors; tennis, running and other exercise that put stress on the ball of the foot.

Treatment for Neuromas

Treatment for neuromas, as with all cases we see, begins with a thorough history and physical examination of the foot with an emphasis on the affected areas. The goal of treatment will be to reduce inflammation around the nerve and prevent further trauma from occurring. Treatment may include, but not be limited to:

• Use of anti-inflammatories to lessen inflammation. Oral medication or cortisone injections can be beneficial in many cases.
• Changing to wider, cushioned shoes without high heels.
• Temporarily changing physical activity to non weight-bearing exercises like biking and/or swimming.
• Physical therapy to reduce inflammation in the affected areas.
• Use of metatarsal pads.
• Fitting of orthotics to correct faulty biomechanics. These devices can be used in smaller heels and all athletic shoes.
• Localized injections into the nerve to temporarily stop transmission of impulses from the affected nerve(s), also known as sclerosing alcohol injections.
• Surgical removal of the nerve may be necessary if conservative treatment fails.

The cases where surgical treatment becomes necessary are few and far between, as most neuromas respond to conservative treatment. In those cases where surgery is required to alleviate pain associated with a neuroma, patients can expect a short outpatient procedure with one-two days of accompanying rest. The procedure is done under local or twilight anesthetic and the patient will need to wear a surgical shoe for the following 4-5 days. Post-operative pain is minimal, but physical therapy may be necessary for a short period. 

Within 2-4 weeks, the patient can progress back to wearing regular shoes. Certain physical activities like swimming or biking can resume within 1-2 weeks, but other sports may require avoidance for up to 8 weeks.

Prognosis (Short & Long-Term)

One word: EXCELLENT!

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Learn more about neuroma treatment and view surgical photos here.