Conservative Treatment

Non-surgical treatment options should first be explored in an attempt to relieve symptoms. Conservative care includes everything from shoe gear modifications to injections of the nerve and is successful in about 50 to 80 percent of cases. Listed below are a few of the treatments that may be attempted by your doctor.

Padding: A strategically placed metatarsal raise pad under the metatarsals will result in separation of the metatarsal heads, thereby reducing nerve irritation. Another method involves placing a 1/8" lift under the fourth and fifth metatarsal heads. This theoretically will free the nerve from entrapment between the third and fourth metatarsal heads by separating the third and fourth metatarsal heads [3].

Orthoses: These are shoe inserts that can incorporate a metatarsal pad to separate the metatarsals. In addition, they will control excessive pronation, which stabilizes the forefoot and decreases the excessive foot motion that may contribute to neuroma formation.

Shoegear: Well-fitted athletic shoes, with special attention to the width, can help reduce current symptoms and can decrease the risk of recurrence. Narrow shoes that squeeze the forefoot together will make neuroma pain worse. Also, avoid shoes with a heel, as they tend to increase stretch and sheer forces on the nerve, which exacerbates the pain.

Try this at home: Place your foot on a blank piece of paper and outline it with a pencil. Place your shoe over the outlined foot. Can you see your pencil outline with the shoe lying over it? If you can, your shoes are too tight-this may be the cause of your neuroma.

Oral Anti-Inflammatory Medication: Non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen and naprosyn can reduce the inflammation around the nerve. These medications come in over-the-counter and prescription strengths-your doctor will discuss your appropriate dosage.

Injection Therapy: The two common agents used in injection therapy of neuroma are corticosteroid/local anesthetic and alcohol sclerosing agent. Corticosteroid is injected around the nerve to decrease the inflammation and reduce fibrosis or scaring. Greenfield found that 30% of patients undergoing corticosteroid/local anesthetic therapy had complete relief of symptoms and 50% had partial relief [4]. Alcohol sclerosing agent is a dilute mixture that includes a small percent of alcohol and a numbing medication. The alcohol is injected around the nerve in hopes of reducing its size. The therapy involves a series of 3-8 injections with 5-10 days between injections. Dockery found an 89% success rate using this method of injection therapy [5].