One of the most common types of foot pain occurs in the ball of the foot under the bases of the toes. This pain is often felt as a hard lump under the foot that can be sharp, stinging, or burning in nature. The pain worsens when a tighter shoe is worn, and feels better in either a looser shoe or no shoe at all. In fact many people report that simply rubbing the foot improves the pain. In addition to all this, there can be numbness, burning, or tingling to the two toes that sit forward from the spot of pain.
The cause of this pain is due to thickening of a nerve that runs in between and under the long bones of the foot, and is known as a neuroma. A neuroma is simply a thickening and swelling of the outer covering of this nerve. There are four nerves that can potentially involved, each running in between the toes in the ball of the foot. Each nerve has two branches, one going to one toe and one going to the toe next to it. The most common nerve involved has branches that lead to the 3rd and 4th toes (the 5th toe being the little toe for reference’s sake). This specific neuroma is called Morton’s neuroma. The other three nerves each have their own name when a neuroma is present, but most people simply refer to them all as a Morton’s neuroma for simplicity’s sake.
The nerve tissue typically becomes irritated due to abnormal pressure on the nerve seen in certain foot shapes, like flatter feet and higher arches. In the case of flatter feet, a thick ligament that sits above the nerve often compresses on the nerve, gradually causing irritation and thickening. In the case of high arches, the abnormal pressure from the high arch shape on the ball of the foot creates excessive irritation to the ball of the foot in general. Tight shoes can also compress the front of the foot, and gradually lead to nerve irritation and thickening.
Neuroma treatment involves two simultaneous steps. The first step is to reduce swelling and inflammation around the nerve. This is typically accomplished with anti-inflammatory medications, steroid injections into the area surrounding the nerve, and icing. Some doctors also advocate more aggressive treatment involving injection of a diluted alcohol solution into the nerve to destroy the fibers, or cold therapy directed into the nerve to serve the same purpose. The second step involves reducing the pressure on the nerve by reducing the pressure to the ball of the foot through arch inserts and appropriate shoes for one’s foot type, as well as ensuring the shoe is wide enough not to squeeze the ball of the foot.
Sometimes the nerve does not respond to the treatment discussed above. In this case, the best thing is to simply remove a section of the nerve surgically. Removing it can result in a small patch of numbness under the ball of the foot and in between the involved toes, but for most people with a painful neuroma this is a fine substitute for the pain the condition causes. Neuroma surgery has a relatively quick recovery, and is quite effective at relieving the pain.
If you are developing pain in the ball of the foot, I strongly suggest you see a podiatrist for timely treatment. Also, keep in mind that there are many other causes of pain in that region, and while a neuroma has some fairly specific symptoms, there can be other causes that mimic a neuroma, or occur along side one. A podiatrist should easily be able to separate these issues and start appropriate treatment.