Is a neuroma really a pinched nerve?

neuroma

A neuroma is a common foot malady that does indeed involve a nerve in the foot, and is often described by health care professionals, general medical doctors or orthopedists, and even podiatric specialists as being a pinched nerve. This is often done to simplify the medical language for a patient, but I think when my colleagues do this they do a disservice to their patients as that description is in actuality not very accurate. I try to avoid the term pinched because it conveys a different sense of what is going on in the foot as opposed to a ‘pinched’ nerve in the back. Nerves in the feet can get pinched in narrow tunnels, primarily at the ankle level. However, the neuroma is a different condition that has more of a mechanical irritation externally causing the nerve damage rather than a constricting band around the nerve itself causing pinching.

In a traditional neuroma, the nerve at the center of the pain is one of five found on the bottom of the foot, between one of the long bones (metatarsals). As this nerve reaches the toe bases, it splits into two branches, each supplying sensation to two adjacent toes. It is at this spot, near the head of the metatarsal, that the nerve becomes inflamed. There is a ligament that sits on top of this nerve that, when bowed down as the foot flexes and flattens a little, can irritate the outer covering of the nerve. Over time, this irritation causes the outer layer to swell and become fibrotic, or scarred. The process is similar, but slightly different, in a high arched foot where there is more direct pressure on the nerve from the prominent and inflexible position of the ball of the foot on the ground. Regardless of the cause, as the nerve covering thickness increases, external pressure on the foot from standing and walking can cause pain to develop. If the scarring is thick enough, the pressure from the adjacent metatarsals can also cause pain if a shoe is tight enough to constrict the foot.

The distinction between this and ‘pinching’ may seem trivial, but in regards to treatment the correct understanding of the underlying cause of a neuroma is very important. Because it is mechanical irritation, and not nerve constriction (pinching), treatment does not necessarily have to involve surgery. In mild to many moderate cases, the simple use of shoe inserts designed to reduce pressure to the ball of the foot can help prevent the nerve from becoming irritated again one the inflammation is reduced with medication. This can in many cases preempt surgery, and still result in long and lasting relief. Although I have performed many surgeries for this condition, I have just as much, if not more, success treating it without surgery.

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