The term neuroma is given to a condition where the forefoot becomes painful. The condition is more common in ladies in the 5th decade and shoewear is felt to be an aggravating factor.
Patients typically complain of a “burning aching” type pain in the forefoot, which is worse in tight or high heeled shoes. It is said that you can tell the neuroma woman in the shopping centre because she is the woman with her shoe off rubbing her foot.
Patients late in the condition develop numbness at the adjacent borders of the 3rd and 4th toes as most neuromas occur in the 3-4 interspace (between the 3rd and 4th toes).
Neuromas rarely occur in the 2-3 interspace (between the 2nd and 3rd toes). They are said never to occur in the other interspaces.
Neuromas, if large, can be seen on ultrasound or MRI which is performed by an experienced operator. Neuromas are not seen on plain x-ray.
The typical history of neuroma is usually diagnostic. Investigations are not routinely required.
The non-surgical treatment of neuromas would involve wider shoes or a metatarsal dome in the shoe.
The role of Cortisone injections is well described. In a series by Kitaoka, 12% of patients experienced a complete cure with one injection of Cortisone.
The definitive treatment once again is surgical. The operation involves one day in hospital, ten days in a wooden shoe and is accompanied by swelling for six months. At surgery one removes the offending nerve and it is effective 85% of the time.