Neuroma pain is classically described as a burning
pain in the forefoot. It can also be felt as an aching or shooting
pain in the forefoot. Patients with this problem frequently say
they feel like they want to take off their shoes and rub their
foot. This pain may occur in the middle of a run or at the end
of a long run. If your shoes are quite tight or the neuroma is
very large, the pain may be present even
when walking. Occasionally
a sensation of numbness is felt in addition to the pain or
even before the pain appears.
like they want to take off their shoes and rub their foot.”
The clinical symptoms should quickly lead your doctor to suspect
When examined, the doctor may feel a "click" which
is known as Mulder's sign. There may be tenderness in the interspace.
The metatarsal bones will also be examined both clinically (and
often with an xray). Tenderness at one of the metatarsal bones
can suggest an overstress reaction (pre-stress fracture or stress
fracture) in the bone.
An ultrasound scan can confirm the diagnosis and is a less expensive
and at this time, at least as sensitive a test as an MRI. An
x-ray does not show neuromas, but can be useful to "rule
out" other causes of the pain.
The source of this pain is an enlargment of the sheath of an
intermetatarsal nerve in the foot. This usually occurs in the
third intermetatarsal space, the space between the third and
fourth toes and metatarsals. It occurs here, at the site third
intermetatarsal nerve, since this intermetatarsal nerve is the
thickest being comprised of the joining of two different nerves.
It also may occur in the other intermetatarsal areas, with the
second interspace being the next most common location.
Pronation of the foot can cause the metatarsal heads to rotate
slightly and pinch the nerve running between the metatarsal heads.
This chronic pinching can make the nerve sheath enlarge. As it
enlarges it than becomes more squeezed and increasingly troublesome.
of the foot can cause the metatarsal heads to rotate slightly
and pinch the nerve...”
Tight shoes, shoes with little room for the forefoot, pointy
toeboxes can all make this problem more painful.
Walking barefoot may also be painful, since the foot may be
functioning in an over-pronated position.
- Wear wide toe box shoes
- Don't lace the forefoot part of your shoe too tight
- Make sure your feet are in supportive shoes that do not squeeze
- Check shoes carefully
- Gait analysis
- Morphological and Physical Examination of Foot
- size, shape, areas of tenderness.
- functional biomechanical examination
- Consideration of other diagnostic possibilities
- Injection of Steroid and Local Anesthetic
- Surgical Removal of Neuroma
Images at University of Michigan Medical School