May 23, 2013

Neuroma and metatarsalgia

Neuroma and metatarsalgia.

Pain in the forefoot is commonly called metatarsalgia. This is a very broad term that encompasses many different types of conditions. One of the most common causes of metatarsalgia is due to a neuroma.

A neuroma is a benign thickening of the nerve that passes down between the metatarsal bone and divides into branches that go into the toes. When this nerve is inflamed and swollen, it is termed a neuroma. What is often the case is that the nerve has become thickened by fibrosis (perineural fibrosis), and this is aggravated by ground reaction forces, tight footwear, or abnormal biomechanics.

Nerve of the foot

Most common location for a foot (Morton’s) neuroma.

A common symptom is shooting pain, burning and tingling, most commonly affecting the 3rd and 4th toes.

However, sometimes when the symptoms are classically suggestive of a neuroma, imaging such as an ultrasound or an MRI scan will fail to show one up. More often than not, another issue called adventitious bursitis is present. A bursa is like a tiny sack of fluid, and it can also inhabit the same area as the nerve which is affected by a neuroma. There mere fact that the bursa is inflamed (bursitis), can then put pressure of the nerve, reproducing the common symptoms that typify a neuroma.

Treatment for these conditions include a variety of methods including orthotics, shoe modifications, injections and sometimes surgical excision.

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