WHAT IS A PLANTAR NEUROMA?
A plantar neuroma is a swelling or scarring of a nerve that runs between the base of the toes. The nerve functions to provide sensation to the toes. The symptoms include pain or numbness to the toes and can present depending on activity level and shoe gear. A neuroma is sometimes described as a tumor, but is typically not a cancer. The symptoms of a neuroma being with pain or numbness. Additional symptoms include burning and tingling in the toes, feeling like there is a thickening or a lump in the ball of the foot and many of these symptoms are elicited when walking or wearing tight shoes. Often, as the process worsens the patient will feel shooting electrical pain in the foot, even when you are non-active. This pain and electrical feeling can start to travel up your ankle and into the back of your leg if you let it go to long.
Focused physical exam. As part of the physical exam we will squeeze the area of the foot just before your toes. If the neuroma mass is present a click can be felt by the doctor. This exam might elicit the pain as well. This exam is called a Mulder’s sign.
Diagnostic tests can be performed to confirm the mass is presents and to identify the etiology of the mass. An x ray can show if the long bones in your foot are too close to one another, or are enlarged, which is causing the irritation and enlargement of the nerve. An MRI or ultrasound of the foot can help identify and locate the mass but are often not necessary.
WHY DO I HAVE A PLANTAR NEUROMA?
To understand this process, we must review the anatomy of the foot. The nerve that is generally in question is called an intermetatarsal nerve. This nerve starts at about the mid foot and runs between the metatarsals
or the long bones that are located behind your toes. As the nerve continues to the toes, it dives beneath a band of tissue that holds the head of the metatarsals together. As it passes that band, the nerve splits into
two nerves and provides sensation to the area between the 2nd, 3’d and 4’h toes. Or to word it differently, the nerve provides sensory innervation to the space between the2″d,3’d and 4th toes.
The neuroma develops just beneath or about the area of the band of tissue that holds the metatarsal heads together. The constant rubbing of the band of tissue and irritation from the metatarsal heads begins to scar the nerve. This begins to send a signal back to the brain that there is something wrong and after continual irritation the signs and symptoms we discussed earlier will arise. High heeled shoes, tight shoes, and increased body weight can also aggravate this process.
HOW CAN I TREAT THIS PROBLEM?
Changing your shoe gear to flatter or wider shoes can help. Also resting the foot can help. Nonsteroidal anti-inflammatory medication like Advil and Aleve can provide further relief. Wearing good arch supportive shoes may also help.
WHAT WILL MY DOCTOR DO FOR THIS PROBLEM?
After attempting home treatments, please seek the care of Dr. Heath after the diagnosis is made, we can attempt many ways to treat this problem. From conservative cares to surgical removal of the deformed part of the nerve. We have the most current techniques to heating this problem. The latest technique for treating a plantar neuroma will be utilized. This with the conservative cares may include steroid injection, alcohol nerve injections, orthotics with special pads, physical therapy.
If the conservative treatments are unsuccessful surgery is the ultimate option. We utilize the latest techniques in surgery. This can include minimal invasive technique to release the band of tissue that is initiating the nerve or removal of the nerve. Along with release of the tight band of tissue pushing on the nerve between the metatarsals and removal of the prominent bone between the metatarsal heads. The decision on the type of procedures is case dependent and will depend on the patient.
CAN I PREVENT THIS FROM HAPPENING AGAIN?
Shoe gear alterations including proper fitted and supportive shoes are the key step. Next using custom orthotics in the shoe will help prevent recurrence. Maintaining well repaired shoe, will further help prevent recurrence. If your pain does return, seek our care immediately. Treatment of acute pain rather than chronic pain is easier.