In most cases, initial treatment consists of padding and taping to disperse weight away from the neuroma. If the patient has flatfeet, an arch support is incorporated. The patient is instructed to wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered. The patient is advised to return in a week or 2 to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient's foot and the type of shoes the patient wears. It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position.
Another type of therapy that may be used is alcohol sclerosing injections. In this treatment, the doctor injects a small amount of alcohol in the area of the neuroma area to help harden (sclerose) the nerve and relieve the pain. Injections are given every 7–10 days and, in many cases, 4–7 injections are needed for maximum relief. Please ask your physician for more information regarding this type of treatment.
Conservative treatment does not work for most patients and minor surgery usually is necessary. Two surgical procedures are available. The dorsal approach involves making an incision on the top of the foot. This approach permits the patient to walk soon after surgery because the stitches are not on the weight-bearing side of the foot. The podiatrist maneuvers the instruments carefully through many structures and cuts the deep transverse metatarsal ligament, which typically causes most of the nerve compression. This procedure can lead to instability in the forefoot that may require attention in the future.
The second procedure involves a plantar approach, in which the incision is made on the sole of the foot. The patient must use crutches for about 3 weeks and the scar that forms can make walking uncomfortable. The advantage of the plantar approach is that the neuroma can be reached easily and resected without cutting any structures.
The surgical area contains very small blood vessels, nerves, and muscles and complications can occur. Once the neuroma is removed, the empty space may fill with blood, resulting in a painful hematoma. There is a risk for infection, necessitating careful monitoring by the podiatrist and patient. If the incision site becomes warm or red within a day or two after surgery, or if the patient runs a fever, the surgeon must be contacted immediately.
Recurrence is another possibility. The stump of nerve remaining after resection can begin to grow again. If this occurs, the nerve grows in width and length, creating a burning pain that can be treated by injection or further surgery.
Podiatrist-developed and -monitored.
Original Date of Publication: 01 Jan 2000
Reviewed by: Hai-En Peng, D.P.M., Stanley J. Swierzewski, III, M.D.
Last Reviewed: 21 May 2007
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