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Metatarsal neuroma is a common cause of foot pain in athletes and people who wear tight, ill-fitting shoes. It refers to an unusual growth of nerve tissue along one of the five metatarsals, the long bones in the foot that connect to the bases of the toes. In most cases, a metatarsal neuroma mass appears between the third and fourth toes and only affects one foot. People with the disorder tend to experience pain, burning sensations, and numbness in their feet that becomes worse during physical activity. Most instances can be relieved with a period of rest and wearing more comfortable shoes, though medications and surgery may be necessary in severe cases.
The cause of metatarsal neuroma is not always easy to identify, but several factors may be involved. Athletes and runners who engage in rigorous physical activity on a daily basis may develop neuromas due to the constant pressure on their feet. Wearing high heels or very tight shoes can also contribute to excess foot pressure. In some cases, an acute foot injury can precede the development of a metatarsal neuroma. Finally, people who have flat feet or ankle problems are predisposed to metatarsal nerve damage.
Metatarsal neuroma usually develops gradually over the course of several weeks or months. A person may notice pain or tingling in the ball of the foot just after completing a run or working on his or her feet all day. Early symptoms are usually relieved by removing the shoe and resting the foot. Over time, symptoms tend to become more noticeable and chronic. An untreated case can result in constant, almost debilitating pain that makes it very difficult to stand and walk.
A doctor can diagnose metatarsal neuroma by asking about symptoms, activity levels, and shoe choices. The physician may press on different areas of the toes and foot to identify the most tender area. X-rays may be taken as well to check for bone defects and other abnormalities. After confirming the diagnosis, the doctor can discuss different treatment options.
Most patients with relatively minor foot pain are encouraged to rest for several days and invest in soft, comfortable shoes. Gel inserts can provide extra cushioning and protection when a person is ready to get back on his or her feet. The doctor may also suggest taking over-the-counter anti-inflammatory drugs to help manage symptoms during the recovery phase.
If pain returns or worsens despite conservative treatment, the physician may decide to inject a corticosteroid directly into the affected toe to immediately reduce pain and swelling. Surgery is only considered if other treatments fail to bring relief. A specialist can locate and excise the mass of nerve tissue and repair surrounding tissue. If the problem is related to a bone deformity, additional surgeries may be needed. Months of rest and guided physical therapy are often necessary after surgery before a patient can return to normal activity levels.