101 - Common questions about neuroma
What is a neuroma?
A nerve swelling between the small foot bones causing pain in various parts of the toes. The condition is sometimes associated with a sac or swelling called a bursa .
How will I know that I have a neuroma?
The foot suffers from tingling or shooting into the toes. Pain is usually concentrated between the second and third digits or third and fourth digits, possibly accompanied by a clicking sensation. When the pain has been present for only a short period of time, there is a good chance that reversal of these problems can be achieved with shoes and insoles. Patients often stop walking and rub their foot to make it go away. Go onto tiptoes. Does your pain increase? Have your toes started to splay apart?
Who suffers most?
Women suffer from this condition more frequently than men do and there is a strong association with narrow, thin-soled shoes. Alter you shoes to make sure that they are broader across the front and select a sole that is at lease 4-6mm thick. Avoid high heels and if these are used then do not wear such shoes all day. Patients can suffer from as young as 13 years but usually patients are over 18 years old. Few men suffer from this condition as early as females.
Treating your neuroma . Your Podiatrist will attempt to shrink the nerve by using a corticosteroid injection with local anaesthetic to dampen the inflammation and reduce any surrounding scar tissue. The longer the symptoms remain untreated, the less chance that the injection will succeed. Research has shown that 70% of patients will benefit temporarily up to six months before the problem returns. Only 38% go on longer than six months*. Please remember that steroid is a natural hormone in the body and few problems arise with single small dose injections – no one will become fat suddenly. The most common drug used is methyl-prednisolone (Depomedrone), a synthetic form of steroid. You must let your Podiatrist know if you are allergic to ANY drug .
Advice after a steroid injection.
After the injection you are advised to rest your foot for
24-48 hours. We now only use one injection before reconsidering the diagnosis. Repeat injections are used in certain cases. Should your symptoms not benefit after 12-16 weeks other treatments may be used. If your pain is very bad This is usually due to a flare up which can take 3-4 days to settle. The risk is around 3-4%
Can I have problems with injections?
Steroid injections into feet seldom causes problems and in less than 4% of cases there is a flare up . This means that you develop an inflammatory swelling with increased pain. This subsides usually within two days and is helped with ice on top of the foot and analgesic medicines such ibuprofen or paracetamol
(make sure that you are not allergic to these first). Sometimes skin colour can change or the fat may thin dimpling. This again is very rare.
What does surgery entail ? Surgery is commonly used to manage this problem. The nerve is usually found to be much thicker due to small blood vessels being damaged. This causes the surrounding lining of the nerve to scar and produce abnormal conduction of

101 - Common questions about neuroma nerve signals i.e electric shocks. The nerve will be sent off to be analysed to ensure that the diagnosis was correct. Remember to ask for the results of this analysis.
What happens after surgery and how do I know that the neuroma has gone?
After surgery pain should slowly go within 3-6 weeks and by 12 weeks there should be little of the old pain left. The scar on top of the foot may thicken but usually becomes lighter and disappears over 24 months. A scar under the sole can develop callus and corns and very occasionally a painful scar. The toes may be a little "dead" or numb to touch but this is rarely a problem for most patients provided that they have been told about it before it happens.
Do I have to have surgery or an injection?
No you can try changing your shoe design and wear an insole or metatarsal pad. If this does not work, then it is worthwhile having an injection of corticosteroid. Some patients benefit from reflexology a form of deep manipulation.
Past audit - Tollafield & Williams. 1996 The use of two injectable corticosteroid preparations used in the management of foot problems – a clinical audit report Br.
Journal of Podiatric Medicine 51(12)171-174