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Common foot complaints:

Neuromas, a cause of forefoot pain.

Definition
There are many causes of forefoot pain (also known as metatarsalgia), of which a neuroma formation is only one. It is essential that pain within the forefoot is assessed by a State Registered Podiatrist / Chiropodist as to the cause of the presenting pain.

As already mentioned, neuromas are a cause of forefoot pain. A neuroma is a pathological benign enlargement of a nerve, which may bring about altered sensation or pain. Neuromas can affect many nerves within the foot, however a common site is of the nerves that run between the metatarsal bones of the foot. These nerves pass forward and branch into adjacent sides of the toes. The nerves most commonly effected are those to the 3rd and 4th toes (also known as a Morton’s neuroma) and the 2nd and 3rd toes.

The cause of neuroma formation is primarily related to internal forces causing stretching and compression of the nerve. Once the nerve is enlarged it then becomes more prone to compression.

Neuromas of the forefoot usually present with a burning pain that can radiate into the toes. The toes may also feel numb at times. The pain is sometimes alleviated by the removal of constricting footwear. You may note a splaying of the two related toes to the area of pain. Compare the affected foot to the unaffected foot.

Incidence / Age
Forefoot neuromas tend to occur most commonly between the ages of 18 to 60 years. They are more frequent in women than in men. More than one nerve in the same foot can be effected.

Treatment
If you are suffering any sort of forefoot pain it is advisable to consult a State Registered Podiatrist / Chiropodist. There are a variety of therapies used in the treatment of forefoot neuromas. These include both conservative and surgical. Conservative treatments can in some people bring about a full resolution of symptoms experienced. For many people surgery is the only action able to achieve a complete remission of presenting symptoms. Some of the common treatments available are listed bellow.

Self treatment
Self treatment for neuromas can only involve footwear modification or selection.

Shoes: It has been suggested that laterally constricting footwear may reduce the spaces between the metatarsal bones of the forefoot making compression of the nerves between these bones more likely. The chances of resolution of a neuroma once present, using footwear modification alone, is unlikely.

Clinical and biomechnanical treatments
On consulting a State Registered Podiatrist / Chiropodist a full assessment will be carried out to establish a firm diagnosis and to consider possible aggravating factors. Once this has been done suitable treatment lines will be discussed. Some of the more commonly available treatments are listed below.

Injection Therapies: Local anaesthetics and steroids are often used in the treatment of forefoot neuroma. Steroids are used primarily to reduce inflammation at the site of injection, this being about the neuroma. More than one injection may be required. Occasionally symptoms may be exacerbated following injection, however the exacerbation of symptoms will subside.

Biomechanics: Biomechanical therapies are used in the treatment of neuromas if the cause is considered to be primarily mechanical. Insoles (orthotics) are manufactured to stabilise the foot and to help prevent further stretching and compression of the neuroma.

Surgical
The only way to ensure the complete resolution of symptoms associated with a forefoot neuroma is by excision of the neuroma. This is a relatively simple operation, which usually involves the placement of a small incision on the top of the foot. The operation is often carryout under a local anaesthetic on a day case basis.

The operation is very successful in alleviation of symptoms, however it should be noted that there can be some permanent numbness in the two toes supplied by the nerve affected. This numbness is usually slight and is rarely of any concern following the operation.

Outcome / Prognosis
Forefoot neuromas are a pathology, unlikely to fully resolve without professional treatment. Both conservative and surgical therapies are available for the treatment of a forefoot neuroma. Surgery offers a complete resolution of associated symptoms when indicated.

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