Neuroma

Iis a name given to a scared and enlarged nerve that is between the two lessor metatarsal heads.  The most common place for a neuroma to occur is between the third and forth metatarsal heads.  The third and forth metatarsal heads connect to different bones in the middle of the foot and with twisting of the forefoot during gait, these two bones rotate in separate directions causing the nerve to become pinched.  A neuroma is a condition that occurs from repetitive injury to the nerve that is running under and between the metatarsal heads in that the nerve enlarges with scar tissue.  The primary cause of the nerve injury is from a twisting of the forefoot while walking that is associated with flattening of the foot or pronation.  The nerve innervates the inside bottom area of the two toes that the nerve passes between.  With injury to the nerve, the typical pain that is experienced is an electrical burning pain that may leave the toes numb intermittently.  Usually the pain is not subtle but very obvious and occurs on and off during weight bearing.  The pain can also continue into the night even after the foot is rested.  The clinical examination is classic for radiating pain when the nerve is pushed on from below and between the metarsal heads.  Sometimes there is even a click that occurs or a marble feeling to the bottom of the foot with walking as the nerve becomes enlarged with repeated injury.  With each injury to the nerve the nerve enlarges with scar tissue that is a mixture of scar and nerve tissue.  It is the repeated scarring that is the cause of the pain as the nerve tissue has no where go when you are standing on your foot and the metatarsal bones are above and around the nerve.

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