Neuromas – Naples Podiatrist Explain That Marble Causing Pain In Your Foot


How do you know if you have a neuroma? Here’s one common experience: If you feel as if you are walking on a marble – sort of a nagging pain under the ball of your foot in the region of the second and third or the third and fourth toes, where you can only seem to relieve the pain by rubbing that area – there’s a fair chance you have a neuroma, and you’re probably going to want to see a foot doctor about it.

It’s not really a marble, of course, and it’s certainly unlikely to prove as big as one (though it might feel that way). What has usually happened is that you’ve worn tight footwear or in some other way managed to cause a nerve junction to be pinched between the metatarsal bones, resulting in a thickening of the nerve there, and leading to pain and tingling.

You probably won’t see the neuroma, as uncomfortable as it is. There is not usually anything visible on the surface of the foot, so a clinical examination is required to rule out other conditions – such as a stress fracture, or bursitis, or capsulitis.

If you visit a podiatrist, he will palpate the area and mobilize the joints; he or she may then squeeze the ball of the foot and apply pressure to the spaces between the joints. Sometimes this process will create a palpable “click,” and if this “click” occurs between the third and fourth toes, this is a classic sign of what is called a Morton’s neuroma, the most common neuroma patients are apt to experience.

If the pain is located more specifically over the joint, then one of the other conditions mentioned may be the cause of the pain in your foot. A podiatrist may even run some X-rays to rule out a stress fracture or arthritis.

The better-equipped podiatrist will likely use an ultrasound to provide a more accurate diagnosis, most often to rule out bursitis and capsulitis, which can often be mistaken for a neuroma.

The ultrasound a podiatrist would use for this examination is the kind used for imaging soft-tissue, not to be confused with a therapeutic ultrasound, which is used for physical therapy.

Diagnostic, imaging ultrasound procedures are perfectly safe, entirely non-invasive, and they are conducted by podiatrists to order to get a clearer picture of the soft tissue structures within the feet.

If a neuroma is truly the cause of the pain, the doctor should be able to see an oval-shaped mass between the metatarsal joints. Capsulitis, by contrast, would show inflammation directly beneath the joint itself rather than between them. Indeed, an ultrasound exam is the best way to tell the difference between a neuroma and capsulitis, and this is an important distinction, because a podiatrist will treat the two conditions differently.

With neuromas being eight to ten times more common in women than men, women may need to reconcile themselves toward putting comfort before fashion. High-heeled, tight, or narrow shoes will aggravate the condition, as will very flat, thin-soled flip-flops.

In fact, a change in your footwear is likely to be the first step a podiatrist takes in dealing with your neuroma. On diagnosing you with a neuroma, your podiatrist will generally advise you to wear athletic shoes as the first course of action. Not only will these shoes allow the foot to spread out more naturally, thus taking pressure off the nerve junction, but they will also provide room for some deflective padding, modification of the insoles, or the insertion of custom orthotics.

If the pain from the neuroma is still unbearable after making these changes, your podiatrist may elect to administer a sclerosing alcohol injection or a corticosteroid injection directly into the site of the neuroma. Ultrasound substantially improves the accuracy of locating the most effective place to apply the anti-inflammatory medication.

Sometimes a podiatrist will also recommend cryotherapy or deep tissue massages as a form of physical therapy added to the treatment of your neuroma, in order to decrease pain and inflammation.

If the neuroma is unresponsive to conservative treatments – if that marble just won’t go away, and won’t stop hurting – surgical decompression of the nerve or removal of the mass may be the best remaining option.

No one likes surgery, of course. But the procedure is fairly common and even has its own name: it’s called a neurectomy. (Although the best choice would be nerve decompression — a specialization of The Foot and Ankle Care Center, PA — which makes a neurectomy almost never necessary.)

As one might guess, the surgical removal of a neuroma involves the direct removal of the painful, enlarged nerve mass. It’s difficult to imagine a more conclusive resolution than getting the neuroma out of the foot entirely. This kind of procedure (removing a neuroma surgically) can be carried out on an outpatient basis, and the typical recovery time is usually a few weeks.

For most people, this should clearly be the end of your problem. Some patients, however, even after surgery may still need prescription orthotics to prevent a recurrence.

But don’t worry about surgery just yet. Studies show that fully 80% of patients coming to a podiatrist with a Morton’s neuroma respond perfectly well to a combination of injections, better-fitting footwear, and custom orthotics.

The important thing of course is to catch it early. So if you think you might have a neuroma, don’t put off a quick trip to the podiatrist.

And in fact, if you’re reading this and think you may have a neuroma (or maybe bursitis or capsulitis, which is just as possible), and if you happen to live in Naples, Florida, you should definitely make an appointment with Dr. Christopher Paladino of The Foot and Ankle Care Center, PA, in Bonita Springs, FL.

Your feet really couldn’t be in better hands.

Be sure to schedule an appointment today. Click here to request a consultation.