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Interdigital Neuroma
The term 'neuroma' refers to a painful swollen nerve that can occur commonly in the plantar digital nerve endings at the bottom of the foot. The interspace between the third and fourth toes is the most common location, followed by the interspace between the second and third toes. Why neuromas form is not entirely clear. The most likely cause seems to be an irritation of the nerve over a long period of time. Factors such as constricting footwear, walking on hard surfaces, and previous injuries may be sources of causation. Prolonged irritation of the tissue in the region of the nerve can cause swelling of the nerve. With swelling, the nerve becomes more prone to irritation and thus a cycle of inflammatory pain and further swelling ensues.
One of the most common symptoms of a neuroma is pain localized to the bottom of the foot between the metatarsal heads. Symptoms may increase with walking, and be relieved by resting the foot. The pain or numbness feeling is usually localized to the bottom of the foot, but will often radiate into the toes of the involved interspace. Patients may complain of having the feeling of a marble or stone underneath the ball of the foot. Some patients describe a painful knot moving around on the bottom of the foot.
Surgical Intervention
When pads, injections, oral medications, and footwear modifications are unsuccessful, surgical intervention may be beneficial. Neuromas are generally successfully treated with excision of the painful swollen nerve. Patients may note decreased sensation in the area where the nerve was formerly located, but there also may be considerable resolution of painful symptoms.
There are multiple nonsurgical treatment options that can be attempted for pain relief from a troublesome neuroma. Utilization of a cushioned athletic shoe with a flat heel and a wide toe box to keep pressure off the forefoot is recommended. A stiff-soled shoe or a rigid insert may help splint the forefoot and decrease bending forces on the toes. Treatment with metatarsal bar pads placed on the insole can provide relief by decreasing pressure on the nerve. Anti-inflammatory medications may help decrease painful inflammation and swelling of a neuroma. Sometimes an injection into the involved interspace with a steroid can decrease pain substantially. Injections may also be used diagnostically to determine the location of the neuroma.
Conservative Treatment
After Surgery
Following surgery, careful postoperative care is needed in order to protect the toes while healing occurs. Patients usually go home the same day of surgery. Stitches are usually removed at 2-3 weeks. You will likely be able to bear weight on your heel the first week after surgery. Although we will allow you to put weight on your heel, to help insure a good outcome, we will ask you to walk flat-footed for 4-6 weeks without standing on your tip-toes. A postoperative shoe or walking boot may offer additional protection. Transitioning back into a regular shoe usually occurs around 4-6 weeks after surgery, and at this point you can begin walking with a more normal gait pattern. Impact activities, such as exercising and jogging, may be done safely around 8-12 weeks after surgery. Time off from work depends on occupation but prepare to take off at least 1 week for rest and elevation of the foot.
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