What is it? A neuroma is an enlargement or thickening of a nerve. It’s possible for a neuroma to appear wherever there are nerves; however, certain parts of the body are more susceptible to neuromas. The most common place for them to appear is in the foot. Specifically, neuromas most often form in the nerve running between the third and fourth toe (and less frequently between the second and third toe). In these locations, the neuroma is referred to as a Morton’s neuroma. The nerve that is affected between the toes is a sensory nerve, so when it becomes swollen or enflamed from being pinched, a burning pain is felt at the site of the inflammation and the pain radiates out to the toes.
How do you get it? A Morton’s neuroma is always the result of pressure or trauma to the nerves. What varies is the cause of the trauma. Sometimes the structure of a person’s foot aggravates the nerve and causes a neuroma, as in the case of flat feet or the presence of bunions or hammertoes. Other times, the neuroma develops because of tight, narrow shoes or from continued pressure, such as frequently walking barefoot on tile or the consistent pounding from certain sports, such as running.
How is it treated? Doctors begin treatment with the least invasive option, which includes changing the patient’s footwear, ideally to a shoe with a wide toebox, plenty of cushion, and no high heels. Secondary treatments include icing to reduce swelling, orthotics, which relieve pressure from the nerve, cortisone injections, physical therapy, or oral anti-inflammatory medication. Conservative treatments are effective 80% of the time, but a neuroma that has developed over four to six months may require surgery if a patient does not respond to any of these treatments. During surgery, a one-inch incision is made on the top of the foot and the Morton’s neuroma is removed. Patients are often back in shoes within two weeks.
What can a tech do? Pedicures pose no threat to a client with a neuroma, and they may actually relieve some pain during the massage portion, though if the condition is too advanced or the area is sensitive, a massage could increase pain. Take your cues from your client on what helps relieve her pain and how much pressure to apply. Take every opportunity to educate a client, but never offer medical advice. If you suspect a client has a neuroma, share what you know about neuromas in general. She may want to try icing the area, changing to wider shoes with no heels, or alternating an exercise routine.
What else? One way doctors diagnose a Morton’s neuroma is to give the “lateral squeeze test,” which is performed by squeezing the forefoot from side to side while applying direct pressure to the affected area between the toes. A podiatrist will be able to feel a palpable mass or click during the test. Doctors can confirm their findings through an ultrasound or an MRI. Additionally, a doctor may order X-rays, which won’t show the neuroma but will allow them to rule out other possible causes of pain, such as a stress fracture on the bone.
Dr. Leon Watkins contributed to this article.
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