idiopathic (no defined explanation). There are a variety of treatments to include shoe modifications, foot orthos with metatarsal pad to relieve pressure from the area, physical therapy, nerve block with corticosteroid, and finally surgery for either decompression or excision. There are other less investigated procedures to include ablations of nerve with chemical or
thermal probe and shock wave treatment.
Initial management includes shoe modification, metatarsal pad with or without supportive insole, activity modification and judicious use of anti inflammatory such as ibuprofen if permitted. If this does not produce improvement, I would recommend x-rays to rule out differential causes of pain to include stress fracture, joint disorder. Other imaging techniques for neuroma include ultrasound and MRI. If definitively neuroma then consider nerve block with cortisone and physical medicine. If this all fails, you may need to investigate more invasive treatment such as surgery and if this does not appeal to you some of the other less investigated approaches mentioned.
Jonathan M. Kletz, DPM
The best treatment was to surgically excise the neuroma. It is a simple and easy procedure taking only a matter of minutes. I used an approach through the top of the foot allowing for immediate weight bearing,