“I’ve been to two other doctors for this pain in the ball of my foot and I have to say doc, if you could…you know…skip the needles…maybe…I sure would be happy.”
This is the first thing a lot of patients say to me. Pain in the toes or ball of the foot is very common, but making the right diagnosis is harder than you might think. This part of the foot has only one muscle running from outside (little toe side) to inside (big toe side), but there are 7 tendons surrounding each joint, bones, joint capsule, ligaments, nerves, and fat. Every step you take transfers weight across the ball of your foot as you move forward. The 3 bones on the inside of your foot move as a unit and the two on the outside are another unit. Each bone also has motion of it’s own besides the motion of the toe on the metatarsal bone.
Enough of the anatomy lesson, let’s get to the point. A neuroma is a pinched nerve. Plain and simple, there is nothing more to it. The nerve lies in the space between your metatarsals (those are the bones in the ball of your foot) and divides to send a smaller nerve into each side of the two toes in front of it. The nerve gets pinched against a ligament running sideways from one metatarsal to the other. Easiest way to think of it, the nerve is constantly irritated by pinching against this ligament. That causes inflammation and then scar. The longer this keeps happening the scar gets bigger and bigger until there is a lump. Sometimes you can feel this lump “click” as it rubs against the ligament, ouch!! If your toes are bent upward the nerve is more likely to rub against the ligament so pain is usually worse in heels, going down stairs (you land straight onto the ball of your foot), or hiking up hill. Why does the nerve get pinched? There are two reasons. First, if you have toes that are buckled, bent, sitting on the top of your foot, the nerve is always pressed up against the ligament. Second, there is abnormal motion between your metatarsal heads (that means an unstable foot).
Treatment for neuroma is: 1. Relieve inflammation, 2. Stabilize your foot so the pinching stops, 3. If all else fails surgery.
- Every article on this website talks about relieving inflammation. Do you remember why? That’s right, because, at Desert Foot Surgeons, I always say, you can’t heal until the inflammation is gone. Ibuprofen, Naproxen, Celebrex and other pills can be prescribed to fight the inflammation. Steroid injections can be given if the lump is really big or your pain is just that bad. The steroid can shrink the scar a little bit. Note: Sclerosing injections are different from steroid injections. These use a chemical to destroy the nerve leaving you numb in that area. Before considering a sclerosing injection seek a second opinion to make sure the diagnosis is correct.
- The underlying problem causing the pinched nerve is your unstable foot. Arch supports are a good place to start, but if your foot is hard to control expect me to suggest custom molded foot orthotics.
- Surgery for neuroma is something that I find controversial. I have surgically removed very few neuromas throughout my career, while colleagues of mine seem to remove a few each week. Why do so many doctors surgically remove neuromas? In my opinion it’s because the orthotics are not made correctly or the diagnosis is wrong. Remember I’m the doctor seeing the patients who have failed treatment by other physicians, or were deemed too difficult or too sick to treat. Be cautious when considering surgery for a neuroma. With that said, surgery consists of either removing the nerve that is damaged by scar or cutting the ligament that the nerve rubs against. If you’re the type of person who has toes that are buckled, than the treatment is to straighten the toes and not touch the nerve.
So there you have it. Morton’s neuroma is a pinched nerve in the ball of your foot as the result of you having an unstable foot. If you relieve inflammation and stabilize your foot using orthotics the pain goes away. At Desert Foot Surgeons, I have not needed to surgically remove neuromas. Before you have surgery I would suggest you get another opinion. The diagnosis might not be correct. Think about all of the things in that area of your foot. I will discuss other problems in the ball of the foot in later articles.