Pain in the ball of the foot can be caused by various things, but the most common cause is an intermetatarsal neuroma. An intermetatarsal neuroma, commonly referred to as a “Morton’s neuroma”, is an enlargement and chronic injury to the nerve that runs between the knuckles of the feet. With standing, walking, running, or abnormal foot biomechanics, the knuckles pinch and “clank” on the nerve — hundreds to thousands of times per day. This repetitive and chronic damage to the nerve causes it to enlarge and become intertwined in scar tissue and become a benign nerve “tumor.” An intermetatarsal neuroma can cause generalized pain in the ball of the foot, a feeling of walking on a marble, a feeling of a balled-up sock, pins and needles in the ball of the foot and toes, or many other varied symptoms. Commonly, patients feel sharp and shooting pain in the ball of the foot and into the toes. Sometimes, this pain shoots up into the arch. Often symptoms are relieved temporarily by removing the shoes and rubbing and massaging the foot.
Intermetatarsal neuromas are extremely common in both men and women, but women are twice as likely to suffer from the condition. Shoes that squeeze the forefoot and ball of the foot together significantly increase the risk of developing a neuroma. High-heeled shoes double the risk of developing an intermetatarsal neuroma by squeezing the forefoot together and transferring all of the body weight to the ball of the foot.
Regardless of the cause, the majority of intermetatarsal neuromas are successfully treated conservatively. After evaluation by a foot specialist to rule out other causes of forefoot pain, several non-operative treatments are available and highly successful. Depending on a patient’s age and activity level, treatments vary, but may include anti-inflammatory creams or tablets, non-invasive laser treatments, properly placed injections, padding, and/or orthotics (custom made shoe inserts). If this fails, or if the patient wants a more definitive cure, day-surgical options exist that can solve the condition with little to no recovery time. An endoscopic and minimally invasive procedure is sometimes attempted that has little to no downtime and performed without general anesthesia. This “one stitch” procedure allows the nerve to be freed from pinching by the foot bones with return to full activities and regular shoes in three days. A second procedure simply cuts out the nerve “tumor” and relieves the nerve pain once and for all. Both procedures allow full weight bearing immediately after surgery with no long term or structural alterations. Early diagnosis of a neuroma greatly lessens the need for more invasive treatments and may avoid surgery. The longer a neuroma is neglected, the more the nerve is damaged and the more resistant it is to conservative treatment.
Don’t suffer from pain in the ball of your foot today! It hurts for a reason and can be gone tomorrow!
Houston Foot and Ankle
Offices in Kingwood, Spring, Houston, Atascocita, and Mont Belvieu
Jason C. Miller, DPM, FACFAS
Daren M. Guertin, DPM, FACFAS
Jacob Hord, DPM, FACFAS
Elizabeth Fernandez-Arias, DPM
Laura Richards, DPM
Adam Long, DPM