Skin & Soft Tissue: Neuroma (“Pinched Nerve”)

Neuroma (“Pinched Nerve”)

Basics

  • Benign Tumor of Nerve
  • Caused by Nerve Injury
    • Trauma
    • Surgery (Such as Limb Amputations or Hernia Repair)
    • Excessive Pressure (Tight Shoes or High Heels)
    • Repetitive Stress/Irritation
  • Most Common in Women

Presentation

  • Burning Pain
  • Numbness & Paresthesias
  • Dysesthesia – Abnormal Sensation
    • Allodynia – Pain from Stimuli that Normally Should Not Be Painful (Slight Pressure, Brush of Fabric, etc.)
    • Hyperalgesia – Excessive Pain from Stimuli that Do Normally Cause Pain (Bumping, etc.)
  • Clicking Sensation with Walking
  • Morton Neuroma – Neuroma Between the Third-Fourth Toes
    • “Walking on a Marble”

Diagnosis

  • Clinical (Based on History and Physical Exam)
  • May Consider US or MRI

Treatment

  • Initial Therapy: Medical Management
    • Medication (Tricyclic Antidepressants, Gabapentin or Steroid Injections)
    • Physical Therapy
    • Rest & Ice
    • Shoes that Avoid Pressure on the Neuroma
  • If Medical Therapy Fails: Surgery (Decompression or Excision)

Neuroma of Second Intermetatarsal Space 1

Morton Neuroma 2

Morton Neuroma on MRI 3

References

  1. Matsumoto T, Chang SH, Izawa N, Ohshiro Y, Tanaka S. Interdigital Neuroma in the Second Intermetatarsal Space Associated with Metatarsophalangeal Joint Instability. Case Rep Orthop. 2016;2016:9575917. (License: CC BY-4.0)
  2. Davis F. Therapeutic Massage Provides Pain Relief to a Client with Morton’s Neuroma: A Case Report. Int J Ther Massage Bodywork. 2012;5(2):12-9. Epub 2012 Jun 30. (License: CC BY-NC-ND-3.0)
  3. Climent JM, Mondéjar-Gómez F, Rodríguez-Ruiz C, Díaz-Llopis I, Gómez-Gallego D, Martín-Medina P. Treatment of Morton neuroma with botulinum toxin A: a pilot study. Clin Drug Investig. 2013 Jul;33(7):497-503. (License: CC BY-NC-3.0)