A neuroma is a benign tumor that is formed from the small nerves in the forefoot being pinched between the metatarsal bones. Symptoms commonly described are tingling, numbness, cramping, burning and a shooting sensation to the end of the toes.

The painful condition of a neuroma is most often found between the third and fourth toes. However, neuromas can develop anywhere that a nerve is subject to trauma or friction. Neuromas may be found between any other metatarsal space or possibly under the heel when a heel spur is present. As constant friction and trauma are allowed to progress, the nerve becomes inflamed and enlarged and can become entrapped in the soft tissue.

A common cause of a neuroma is biomechanical imbalances of the foot, such as pronation, or inward rotation. In motion, the foot rolls in and lowers the arch, causing the nerve to become entrapped between the metatarsals. In addition, a neuroma is most frequent in women due to the position and tightness of the foot in high-heeled shoes.

Early treatment of this painful condition is directed towards elimination of all tight fitting shoes, both athletic and street shoes. A great majority of the neuroma symptoms respond well to conservative therapy.

In some cases, placement of a pad to separate the metatarsal heads may help to relieve the symptoms. A local injection of Vitamin B-12 with an anesthetic may help to break the pain cycle and shrink the nerve inflammation. Another form of therapy is a biomechanical orthotic device especially casted to the foot, which will reduce the excessive pronation and entrapment of the nerves.

While early detection and treatment of the condition will usually respond well to conservative therapy, some cases will require surgical excision of the neuroma.

Dr. Robert F. Weiss is a sports podiatrist specializing in foot and ankle surgery. He was a member of the Medical Advisory Committee of the 1984 and 1988 Olympic Marathon Trials. Dr. Weiss is a veteran of 35 marathons, has a practice in Darien and resides in Westport. For more information visit his Web site at www.therunningdoctor.net.