DEAR DOCTOR K:
I have a painful pinched nerve in my foot. What are my treatment options?
The medical term for a pinched or compressed nerve that causes pain and swelling is a neuroma. Neuromas that occur in the sole of the foot are called Morton’s neuromas and are particularly common. They occur in between the third and fourth toes or between the second and third toes (see image below).
A view of Morton’s neuroma
Morton’s neuromas do not always cause symptoms. Some imaging studies have found the neuromas in people without any symptoms. In others, though, like you, the neuroma causes sharp, burning pain and numbness in the toes and foot. Typically it flares up when you are standing. You may feel like you’ve stepped on a tiny hot coal. At the same time, you may not be able to feel your toes.
We think Morton’s neuromas form because one of the nerves between our toes gets injured. The injury may come from tight shoes, from intense or prolonged running, or from any other sport that puts the feet under lots of pressure. The injured nerve starts to swell and tries to repair its injury. This causes a bunch of disorderly nerve endings to form into a little ball — a neuroma.
The first step in treatment is to change your footwear. If you keep pressure off your toes and wear shoes that provide enough room in the toe box, the neuroma may gradually disappear. Your foot-care specialist may recommend lower heels, metatarsal pads, better arch support or custom orthoses to redistribute your weight.
For instant relief when pain flares up, take off your shoes and rub the painful area. This may help a trapped nerve to move back to its natural position. For severe pain, your doctor may inject a local anesthetic combined with a corticosteroid to relieve the inflammation and pain.
Another option is to take a prescription medication that alleviates nerve pain. The choices include amitriptyline (Elavil), gabapentin (Neurontin) and pregabalin (Lyrica).
If your pain is severe or persistent, you may need to consider surgery to remove the neuroma. This involves making an incision in the foot and removing the nerve. A newer surgical option involves a smaller incision and a faster recovery. Once the nerve is gone, you will permanently lose feeling in the affected area.
With any type of neuroma surgery, complications may occur (particularly infections, or difficulty moving the toes near the neuroma), but they are unusual. Several of my patients have gotten relief with surgery, but I don’t know of any large scientific studies (randomized trials) that absolutely prove its value.
One alternative to surgery is neurolysis injections, in which various pain-blocking chemicals are injected into your foot. It’s not yet clear if this treatment is effective.