What is it?
The nerve becomes irritated and thickened where it passes between the metatarsal heads. It is not a tumor. Repetitive compression keeps it inflamed.
What causes it?
- Narrow shoes and high heels
- Activities with repetitive forefoot loading
- Foot structure that compresses the space between the metatarsals
What does it feel like?
- Burning pain in the ball of the foot radiating into the toes
- Numbness or tingling in two adjacent toes
- Feeling like a sock is bunched under the foot
- Relief when removing the shoe and rubbing the foot
How is it diagnosed?
A clinical exam, including compression of the forefoot, is often enough. Ultrasound in the office can visualize the neuroma and helps guide injections.
When should you see a podiatrist?
- Burning or numbness in the toes that keeps returning
- Pain that makes you remove your shoes
- Forefoot pain with no clear cause
Nonsurgical treatment
- Wider, lower-heeled shoes
- Reduce compression.
- Metatarsal pads
- Spread the bones to take pressure off the nerve.
- Custom orthotics
- Improve forefoot mechanics.
- Injections
- Corticosteroid injections can relieve symptoms, particularly when ultrasound-guided.
When is surgery considered?
Surgery is considered when symptoms persist after shoe changes, padding, and injection therapy.
Surgery either releases the ligament compressing the nerve or removes the affected portion of the nerve. Removal leaves a small area of permanent numbness between the toes, which your surgeon will discuss with you.
What is recovery like?
Most patients walk in a surgical shoe soon after surgery and return to regular shoes within a few weeks.
Frequently asked questions
Is a neuroma cancer?
No. It is a benign thickening of nerve tissue.
Why does taking my shoe off help?
It relieves the compression on the nerve, which is why shoe changes are the first step in treatment.