You tell your doctor that you have been experiencing a burning pain and sometimes a numb spot in between the third and fourth toe. With walking, it feels as though something is clicking in your foot and the burning pain is extending into your toes. Some days it seems as though you have a small rock in your shoe, but when you take your shoe off nothing is there. Some patients feel like there is a sock wadded up in their shoe. However, you say that you are able to get some relief from rubbing the bottom of your foot. These are classic signs of what is called a Morton’s neuroma.
Morton’s neuromas are the thickening of the nerve that is in between the third and fourth toes, which is the most common location for Morton’s neuromas to form; in between the second and third toe is the next most common location. There are many theories as to why this might be the case. One of the more probable theories is that your third and fourth metatarsal bones (the bones that the toe are attached to) are the closest together, so when walking the nerve will be rubbed against the two bones. If this is the case, the nerve will try to protect itself by adding layers of more tissue and scarring to protect itself. The clicking sensation that you may be experiencing is due to the increased size of the nerve rubbing in between the third and fourth metatarsals, as well as pushing on the deep transverse metatarsal ligament, which is what connects the third metatarsal to the fourth metatarsal.
Neuromas can be difficult to treat especially if the neuroma has been causing symptoms for years. This is because once the nerve has become thickened it is difficult to reduce the size to get rid of the symptoms. So, if you have the symptoms, it would be better to visit the podiatrist now rather than waiting until it is too late for non-surgical treatment to help.
Another reason to not wait on seeking treatment is that there are not many at-home treatment options to relieve the pain caused by neuromas. It may help a very small amount to rub the bottom of your foot and wear shoes that give enough room for the toes to wiggle. These will not get rid of the neuroma nor will they get rid of all the pain, but it may help the severity of the symptoms.
Podiatrists have many non-surgical treatments options that may help get rid or relieve the symptoms caused by neuromas. Some treatment options are:
- Prescription orthotics
- Adding strategically placed padding to your shoe to help decrease the force in the area
- Taping your foot for more support
- Prescribing various non-steroidal anti-inflammatory medications
- Giving a steroid injection to help mask the pain
- Injections with a sclerosing agent, which will work to make the nerve shrink
- Write a referral for physical therapy intervention
If all of these conservative treatments fail to relieve the symptoms, which isn’t very often, a podiatrist can remove the neuroma surgically. However, surgery may not help the symptoms either since more complications could arise, such as the nerve regenerating inappropriately resulting in more pain. This is why it is so important to not try to “tough it out” because if you wait too long, it might be too late to get relief from the conservative treatment modalities, as well as the surgical procedures.