Do you have pain in the ball of your foot? This can be very frustrating. It hurts in shoes, out of shoes, going up stairs, going down stairs, running, riding a bike, squatting to pick something up, and even walking. It’s no secret that I am not a great believer in neuromas. The ball of the foot has tendons, nerves, joints, bones, ligaments, and even fluid filled bursas can form. Before I jump at the diagnosis of Morton’s Neuroma, I have to make certain that your pain is not due to one of these other possible causes.
A neuroma is a pinched nerve. The nerve to your toes runs between the metatarsals just below a ligament connecting the joints at this level. It is believed that the nerve is pinched against the ligament causing thickening, scar formation, and pain. In a July 2012 article from Foot and Ankle International a study was conducted using ultrasound to look at nerve thickening in people who had no pain in the ball of the foot. Out of 96 feet, the researchers found nerve thickening in 54%. That’s right, more than half the feet studied had nerve thickening, but no pain. Older subjects and those with a “clicking” when the nerve is pushed against the ligament were found to have more thickening than others, but still no pain.
So, if more than half the people out there have nerve thickening without pain, doesn’t that make it more important to make certain that the pain is truly due to this nerve thickening/neuroma versus one of the other possible causes?
Another study from Foot and Ankle International published in September 2012 tested the effect of steroid injection for the treatment of neuroma. What they found is that from the time of injection and up to 6 weeks all feet improved. At 6 months those with larger thickening had return of pain and at 12 months every patient was back to where they started. Here is what happened in this study: the inflammation improved with the initial injection, but that could be the joint, bursa, tendons, or ligaments that were inflamed. Since there was no treatment of the mechanics of the foot using orthoses, all pain returned.
Why not just remove the thickened nerve then? This procedure is called neurectomy and is the final choice for pain attributed to neuromas that has failed to respond to other treatments. An article published in December 2011, Foot and Ankle Specialist studied long term benefits from neurectomy. They found that 11 out of 19 patients had numbness in the ball of the foot after neurectomy; not a surprise since the nerve was removed, but this was bothersome to the patients.
In summary, if you have pain in the ball of your foot make sure your doctor is looking for other causes of pain, not just thickening of the nerve. If you are not improving with the treatment, make sure to get another opinion before undergoing surgery to remove the neuroma.