Neuroma
Acute or chronic injury leading to inflammation and scar tissue to the common digital nerve on the bottom of the foot between the second or third or third and fourth metatarsal bones.
Symptoms
• Pain, numbness, tingling, burning, radiation occurring to the involved digits
• No associated swelling
• Pain predominant to the bottom of the ball of foot region
• Pain sometimes worse with narrow style shoes
Treatment
• Wide toe box shoe to decrease pressure between the involved metatarsal bones
• Shoe with removable innersole to accommodate the use of an orthotic
• Over the counter or custom orthotic to offload the ball of foot region. Orthotic with metatarsal pad or metatarsal bar to additionally take pressure off of the ball of the foot.
• Up to three serial cortisone injections to decrease swelling within the nerve
• Possible dilute alcohol injections to create scar tissue and create nerve dysfunction decreasing nerve pain
• Antifinflammatory medications including ibuprofen and naproxen of little use
• Surgical excison of pathologic nerve as indicated by ongoing pain
