Download Fact Sheet 2 - Consulting Foot Pain

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