“My feet are killing me!”

As someone who worked long hours in retail through University, I frequently had painful, burning sensations in the ball of my foot by the end of each shift.

More often than not, we write this discomfort off as spending too much time standing at work, wearing the wrong shoes, or leading an active lifestyle.

But could a neuroma (also called a "Morton's Neuroma") be the underlying cause of your symptoms?

What is a Neuroma?

A neuroma is a benign (non-cancerous) thickening of one of the digital nerves that run between long bones (metatarsals) in the feet.

This condition is seen more commonly in women than in men.

Neuromas often affect the nerve between the 3rd and 4th metatarsal, but they can occur in any of the digital nerves in the foot.

Neuromas are generally seen in just one nerve in one foot.  But now and then, we see neuromas impacting several nerves in one foot or several nerves in both feet.

Symptoms

Most people with a neuroma describe either a sharp, stabbing, burning, tingling or "pins and needles" sensation in the ball of the foot that can radiate into the toes.

Some also describe the feeling of a stone or something hard underneath the ball of their affected foot.  Very occasionally, the area may be swollen and/or tender to touch.

Symptoms typically appear when wearing shoes - worsen with activity – and then ease off with rest.  High-impact activities or sports involving running and jumping will also aggravate symptoms.

As the condition progresses, pain (and other symptoms) may be present during periods of rest – which is why it is essential to have a neuroma correctly diagnosed as early as possible.

What causes a neuroma?

Although the exact cause remains unclear, neuromas seem to occur in response to pressure, irritation, or injury to a digital nerve.

The following factors may contribute to the development of a neuroma:

• People with foot deformities such as hammertoes, bunions, lower-arched feet (pronated feet), or higher-arched feet (supinated feet) are at higher risk of developing a neuroma.

• Footwear that lacks sufficient width across the toe-box (forefoot) will squeeze the metatarsals together and compress the digital nerves.  High heel shoes also strain the ball of the foot (and therefore the digital nerves).

• Occupations that involve long hours on your feet and/or tasks that involve frequent hyperextension of the toes place repeated stress through the forefoot region (think nurses, retail workers, warehouse staff, house painters, etc.).

• High-impact sports such as jogging or running subject the forefoot to repetitive trauma.  While sports like snow skiing or rock climbing necessitate tight shoes that may compress the digital nerves.

• Trauma can cause damage to the digital nerve that results in inflammation or swelling of the nerve.

When to see a podiatrist?

If these symptoms sound familiar, we recommend seeing your podiatrist for a full assessment and diagnosis as soon as possible.

During the examination, your podiatrist will feel for the enlarged nerve or a "click" between the bones (officially known as a positive "Mulder's sign").

Your podiatrist may also refer you for diagnostic ultrasound and/or x-rays of the affected foot to rule out other underlying conditions and confirm the neuroma's size.

The more quickly a neuroma is diagnosed, the faster it can be managed.  If left untreated, neuromas may get worse with time.

Treatment

The good news is that neuromas are very manageable, and the vast majority of cases respond to conservative therapy without the need for injections or surgery.

Your podiatrist will recommend appropriate treatment based on the severity of your symptoms and the size of the neuroma.  Most initial therapies are simple and non-invasive.  

Initial treatment options include:

• Footwear assessment, education & modification -

• your podiatrist will not only look at the length but, more importantly, the width of your shoes to assess if footwear may be contributing to the problem;

• your podiatrist will also assess the height of the heel of your current shoes;

• and finally, your podiatrist will assess the sole of your shoes to ensure that there is adequate shock absorption.

Want to learn more about buying the right shoe? Click on link here.

• Orthotic therapy - your podiatrist may apply a 'metatarsal dome' to your shoe or orthotics, which spreads the metatarsals and reduces pressure on the affected nerve.

• Taking a short break - from activities (and shoes!) that exacerbate symptoms will give short-term pain relief.

• Oral anti-inflammatory medication - if suitable for you.

If conservative treatments do not work – or if the size of the neuroma is quite significant to start with – your podiatrist may recommend:

• Corticosteroid injection to ease acute pain and inflammation caused by the neuroma; or

• Surgery to release the tissue around the nerve (which relieves pressure on the nerve) or remove a small part of the nerve.

So if, after a long day, you swear, "My feet are killing me!" get to your podiatrist quick-smart! You never know; you may just have a neuroma.

This article was originally published on the Blackwood Podiatry Blog in April 2021. It has been updated by Nicole Morgan in February 2024.