Metatarsalgia Part 1: Neuroma, Neuroma, wherefore art thou Neuroma?
How’s winter treating you? Had enough yet? Yeah, us too, so we thought we would give you something to look forward to while you wait for the weather to warm up: a three part series on metatarsalgia. A trilogy if you will. How exciting is that!
This is a broad term used to describe pain around the ball of the foot – the padded area just back from your toes. There are a number of problems that cause metatarsalgia so the generalized diagnosis is often not helpful in explaining why you might be in pain. It’s also not helpful for developing a treatment plan as the different conditions that make up metatarsalgia all require very different approaches.
Welcome then to Part I - Neuroma
Also known as a Morton’s neuroma, it is a nerve entrapment of a plantar digital nerve of the foot, most commonly the one between the third and fourth metatarsals but can also occur between the first and second, and fourth and fifth metatarsals.
The plantar digital nerves lie between the metatarsals (long bones in the feet) about 5-10mm deep to the bottom of the foot (plantar surface).
There are 3 main factors that predispose to a neuroma developing:
Compression of the nerve from footwear (such as high-heels)
Pressure from bursa especially inflamed bursa (more on this next month)
Biomechanical causes which include an inverted forefoot and excessive pronation (rolling in)
What does it feel like?
A neuroma causes sharp, shooting, burning pain into the area directly underneath the metatarsal space where it lies and into the toes. Pain can also occur during rest and travel into the foot or up the back of the leg. Weight-bearing activities, tight or thin-soled shoes and high heels often exacerbate it. It can feel like you are walking on a pebble or stone with numbness around the area and into the toes as well.
Treatment of the underlying cause is essential as well as treatment of the symptoms. Orthoses may be needed to address any biomechanical issues as well as a change in footwear. Anti-inflammatory medication may help reduce local inflammation as will a cortisone injection.
If all of these conservative measures fail, however, surgical intervention may be needed.
Another reason to make sure you wear appropriate footwear!