Neuroma

The term neuroma refers to a painful inflammation that can occur in one of the nerves in the bottom of the foot.

The space (interspace) between the third and fourth toes is most commonly affected with the space between the second and third toes the next most commonly involved.

Why neuromas form is not entirely clear. The most likely cause seems to be an irritation of the plantar digital nerve branches over a long period of time. Irritating factors such as faulty footwear, walking on hard floors, standing for long periods of time, and previous injuries may be a source of irritation. Prolonged irritation of the tissue in the region of the nerve can cause thickening of the nerve.

The most common symptoms of an interdigital neuroma is pain localized to the bottom of the foot between the metatarsal heads. The pain often increases with walking and is relieved by resting the foot. The pain is usually well localized to the bottom of the foot, but will often radiate to the tips of the toes of the involved interspace. Occasionally there is a feeling of numbness in the distribution of the nerve itself. Also, occasionally patients complain of having the feeling of a marble or stone underneath the forefoot region or the feeling that there is something moving around on the bottom of the foot which when caught in the right position causes acute, sharp pain.

Treatment with metatarsal pads can give temporary relief as well as an injection into the involved interspace with cortisone and local anesthetic. Sometimes an injection is useful in determining which interspace is involved.

The Surgery

The surgical removal of forefoot neuromas is a relatively simple procedure. A foot block is used to numb the foot and a small incision is made on the top of the foot. This is an outpatient procedure and usually a patient is at the hospital for approximately two hours. 

Following administration of anesthesia, a skin incision is made on the top of the foot in the location of the neuroma. This is most commonly in the area between the second and third toes or between the third and fourth toes. The neuroma is then easily found between the long bones (metatarsals) behind the toes. After the nerve is identified it is cut and removed. The nerve is often sent to pathology for microscopic examination to confirm the diagnosis.  

Post Operative Care

Once the surgery is completed a gauze dressing is applied. This bandage stays in place until the surgeon sees the patient on their first post-operative visit a few days after surgery. On the first post-operative visit the surgical site is inspected and a new dressing is applied. The sutures are removed in 3 weeks following the surgery. During this period of time the foot must remain dry to reduce the risk of infection. We recommend the patient limit their activities and keep their foot elevated above the heart. A post-operative shoe is worn for six weeks.  During the first 3 weeks, the patient is allowed to do limited walking on the heel. The patient should not walk with out the post-operative shoe or put weight on the ball of the foot.  After sutures are removed, the patient can then walk normally in the post op shoe. Once the sutures have been removed the patient may also bath the foot. 

Recovery Time

The time required to be off from work will depend upon the type of work being performed and the type of shoe that must be worn. If the patient can work with their foot propped up and elevated with limited walking they may be able to return to work within a week of surgery. Patients who have jobs that require prolonged standing, walking, kneeling or climbing may be off from work for as long as four to six weeks.