Foot neuromas occur when an intermetatarsal nerve (see right) is irritated and becomes inflamed. Prolonged irritation of the nerve causes thickening and sometimes scarring. It most commonly occurs between the 2-3 or 3-4 metatarsal spaces in the ball of the foot, but the pain often radiates into the 2nd, 3rd or 4th toes. The pain is generally worse when walking, running or climbing stairs and improves while resting. Neurological symptoms such as tingling, numbness and shooting pain may accompany the condition.
Click here to for information on diagnosing foot neuromas.
Treatment of Foot Neuromas
To treat a foot neuroma we must first eliminate those factors that are causing the nerve irritation. This could include restrictive footwear, poor foot biomechanics or weak or tight muscles. After addressing these issues through orthotics, footwear modification, anti-inflammatories, stretches and strengthening exercises, some cases of stubborn neuromas will continue to cause pain.
It is these recalcitrant, stubborn cases of neuromas that can find relief through shockwave therapy.
A 2009 study published in the Journal of the American Podiatric Medical Association found that shockwave therapy can be effective for treating interdigital or Morton’s neuroma. The study used 25 subjects with a neuroma’s that had received a minimum of 8 months of conservative therapy. These subjects were randomly divided into 2 groups – 1 treatment group and 1 control/placebo group. Both groups were sedated and given local anaesthetic before the treatment group receiving shockwave therapy treatment. At the 12 week follow up 40% of the control group had seen significant improvement in symptoms, while in the shockwave treatment group 69% of subjects experienced significant improvement in symptoms. 30% of the control group experienced no improvement in symptoms while only 8% of the treatment group experienced no improvement in symptoms.
Extracorporeal shockwave therapy delivers high energy sound waves to the body’s tissues, triggering the healing process by initiating new blood vessel formation and drawing healing cells to the area of damage.
At Performance Podiatry Sydney we have been using shockwave therapy as an adjunctive treatment for foot neuromas. It has been a great addition to our ever-growing repertoire of treatments available for painful foot conditions, namely stubborn foot neuromas.