What Is a Neuroma?

A neuroma—a.k.a. a nerve tumor or "pinched nerve"—is an often painful but typically benign abnormal growth of nerve tissue. Neuromas can occur anywhere in the body. A common type of neuroma in the foot, called Morton's neuroma, grows between the third and fourth toes. The hand is another common site for a neuroma to develop.

This article explains neuroma symptoms and their causes. It presents information about when you may want to see a healthcare provider for a possible diagnosis and neuroma treatment.

What Are the Symptoms of a Neuroma?

Neuromas involve thickening of the nerve tissues, which often causes severe nerve pain. A neuroma can also change the way your brain interprets touch and lead to pain types categorized as dysesthesias.

Dysesthesias are defined as abnormal sensations. These can be painful or just unpleasant, although that distinction can be hard to make.

Neuromas are associated with two types of dysesthesias, both of which cause often significant pain:

• Allodynia: This is pain from stimuli that shouldn't cause pain, such as a light brush of fabric against the skin, moderate heat or cold, or a small amount of pressure from a waistband that's not too tight.
• Hyperalgesia: A heightened feeling of pain from stimuli that is normally painful. For example, bumping a body part against a door jamb might normally be a three or four on the pain scale, but a six or seven for someone with hyperalgesia.

More specific symptoms depend on the region of the body where the neuroma forms. In Morton's neuroma, symptoms include:

• Burning pain in the ball of the foot that may radiate into the toes
• Sharp, tingling pain that intensifies with activity
• Pain that's exacerbated by wearing shoes, especially if they're tight or narrow
• Numbness or unpleasant sensations
• Clicking sensation when you walk
• Pain after taking off shoes
  

People with neuromas are at risk for developing pain in a larger area from something called complex regional pain syndrome (CRPS). This usually develops over time, but can also happen post-surgery. CRPS can lead to additional symptoms in nearby tissues and structures, such as:

• Changes in circulation and sweat production
• Changes in hair density
• Decreased bone density

Typically, these symptoms will improve when the neuroma is successfully treated.

Causes

The neuroma is basically a ball of scar tissue and long threads called axons, which form as the nerve attempts to heal. Not all neuromas are painful, but people don't usually notice the ones that don't hurt.

Neuromas are caused by injuries to a nerve, which can be a laceration (cut), a crushing injury, nerve compression, or an excessive stretch. Common causes include:

• Surgery, especially limb amputations, mastectomy, or hernia repair
• Certain shoe styles—be them tight, high-heeled, pointed, or ill-fitting—that affect the foot and its natural alignment
• Flat feet or other genetic abnormalities
• Bunions
• Repetitive stress
• Pregnancy
• Illnesses such as rheumatoid arthritis or gout

When neuromas form after surgery, it can cause pain to persist long after the expected surgical healing time. This can lead to chronic postoperative pain.

While neuromas are often associated with amputations, they don't cause phantom limb pain. However, they can make it difficult or impossible to wear a prosthetic.

Diagnosis

To diagnose a neuroma, your healthcare provider will ask you about your symptoms and perform a physical exam.

Often, they'll do what's called Tinel's test, which involves tapping over the path of the nerve to see if it causes pain or tingling.

Depending on the location of the suspected neuroma, they may also feel for a distinctive lump in the painful area.

You may also be sent for imaging. An X-ray can help rule out other potential causes of pain, and ultrasounds are good at spotting neuromas. Magnetic resonance imaging (MRI) is sometimes used, but it can lead to false-positive results and is much more expensive than an ultrasound.

Healthcare providers sometimes use a nerve block as well, which means they inject an anesthetic at the site of pain or along the known pathways of nerves believed to be involved. If it alleviates the pain, that confirms the diagnosis.

Treatment

The initial treatment for a neuroma is nonsurgical and may involve medications, physical therapy, or both. Common medications for neuroma include:

• Tricyclic antidepressants, such as Elavil (amitriptyline): These drugs change how the central nervous system processes pain signals. For neuromas, they can provide some relief from burning and tingling.
• Anticonvulsants, such as Neurontin (gabapentin) and Tegretol (carbamazepine): These drugs are shown to relieve nerve pain in some people, but evidence for their use with neuromas is limited. They're considered an alternative for people who can't tolerate tricyclic antidepressants or an additional treatment for those who need more relief than tricyclics offer.
• Serotonin norepinephrine reuptake inhibitors (SNRIs), such as Cymbalta (duloxetine). SNRIs are commonly used to treat nerve pain and, like tricyclics, alter the way your brain processes pain signals.
• Corticosteroid injections, such as Medrol (methylprednisolone): These medications are powerful anti-inflammatories. They can help relieve nerve compression from inflamed tissues.

Anti-inflammatory medications, such as NSAIDS (e.g., ibuprofen and naproxen sodium), are commonly used as well.

Several physical therapy techniques can be used for neuromas, including:

• Desensitization exercises: This involves rubbing the residual limb with different textures to gradually decrease hypersensitivity.
• Electrical stimulation: This involves weak electrical current delivered to your muscles via electrodes. It can help alleviate muscle spasms, inflammation, and pain.
• Ultrasound: This provides deep heating to your soft tissues, which is thought to help them heal. This is a different procedure from ultrasound imaging, which is a diagnostic tool.

Using ice to relieve swelling can also be effective.

Surgery

If other treatments fail, your healthcare provider may recommend surgery. Two types are common:

• Decompression, which is done by cutting nearby structures that put pressure on the nerve
• Nerve removal, which can result in permanent numbness in the affected area

Unfortunately, it's not uncommon for a new neuroma to form where the incision was made during nerve removal.

All surgery comes with risks, so it's usually considered best to try conservative treatments first. If you are considering surgery, make sure to discuss all potential risks with your medical care team.

Prevention

Neuroma prevention depends on the specific type of neuroma and its cause. For Morton's neuroma, lifestyle changes may offer benefits. These options include:

• Resting and icing the area after activity, especially if it's sports-related
• Wearing softer, wider shoes with plenty of room in the toes; avoiding tight, narrow shoes
• Getting shoe inserts that relieve pressure on the neuroma

You also may want to adapt some activities that you don't realize are creating stress on your foot, such as bicycle riding. Even the hours you sit in an office chair may matter. One study of 100 people with Morton's neuroma found that office chair design may contribute to neuroma development.

A Word From Verywell

A neuroma can't be "cured" and, like all chronic pain, should be diagnosed and treated by a healthcare provider.

However, treatment options including lifestyle changes, medication, and surgery are quite successful in treating many neuromas.