What is a Neuroma?

A neuroma is when a nerve in the front of the foot becomes irritated and enlarged.

What are the causes?

A neuroma is thought to be caused crowding of the forefoot. This might be a tighter shoe at the toe box or activity that might be putting increased pressure on the feet. An increase in weight can contribute to symptoms flaring. As we age our foot posture tends to spread and get wider, due to ligament changes. It’s important to adjust your footwear needs to foot shape changes.

What are the symptoms?

Pain, numbness, burning, and tingling sensations are the main symptoms. This can be described as the feeling of walking on a pebble with pressure of the forefoot to the ground. Numbness and tingling may extend to the toes.

Weight Loss

If you have put on weight or are considered over-weight than this might be impacting your foot symptoms. Eating a healthy diet or following a weight loss programme might help reduce your foot pain in the long term.

See our “Healthy Living” section for more information on local healthy weight services

Activity Modification

A reduction in impact activities might help reduce your symptoms or even simply wearing a cushioned shoe around the house, as pressure can be an aggravator.


Wide fitting shoes are recommended to help reduce squeezing of the foot and aggravation of the nerve. Slip on shoes, tighter toe box, stiff materials around the bunion are not going to help if your neuroma foot pain. A decent cushioned sole shoe/trainer that is not easily compressed under the ball of the foot is important. See footwear advice

The Correct Shoes for Insoles – YouTube

Pain Relief

Over the counter painkillers like paracetamol or ibuprofen will ease the pain, but need to be taken regularly in order to control the pain. Follow the instructions on the packet and discuss using them safely with a pharmacist or GP, especially if you have any underlying health conditions.


Metatarsal Padding

Adding cushioning under the ball of the foot can help with symptoms these are known as metatarsal straps. A metatarsal strap/sleeve goes over the front of the foot offering gel padding for comfort.

Pro11 Gel Metatarsal Pads – ShoeInsoles.co.uk

Pro11 Ball of Foot Fabric Support with Gel Pad (Pair) – ShoeInsoles.co.uk

Metatarsal Pads/domes (made out of foam or fabric) can also be stuck onto the insole inside your shoes. These pads are often stuck just behind the ball of the foot to deflect pressure and splay the foot. These can work well for many neuroma cases but for some patients they find the pad awkward object under the foot and a cushioning is preferred.

Pedag T Form Metatarsal Supports – ShoeInsoles.co.uk

Pedag Drop Metatarsal Supports – ShoeInsoles.co.uk

Podotech Polyurethane Metatarsal Pads – ShoeInsoles.co.uk

Basic Metatarsal Domes – ShoeInsoles.co.uk


metatarsal dome placement – how to do it your self – YouTube


The aim of these foot exercises is to help reduce symptoms by mobilising the forefoot joints and strengthening foot muscles to provide stability when you are putting weight on the front of your foot.

Toe Mobility

  1. Place your foot on your knee (if you can).
  2. Grab the toes and pull them towards you. Lightly moving them back and forth.
  3. Aim to move joints of the forefoot back forth.

Toe Mobility Rolling over a ball

  1. Whilst seated, place your foot on the floor resting the front of the foot on a ball
  2. Lightly roll the toes over the ball by extending and flexing over the surface of the ball.
  3. This can help mobilise the painful forefoot to aid recovery

Toe Motion Exercise – An easy three-step exercise to help strengthen your feet – Insoles and Orthotics – Healthy Step

Foot Therapy Ball – Simple exercises to help strengthen your feet – Insoles and Orthotics – Healthy Step

Towel Grab

  1. Sit up straight in a chair with a towel placed under your forefoot.
  2. Curl and release your toes to pull the towel towards you.
  3. Keep your heel on the ground.
  4. To progress, place a weight on the towel.

Foot Doming

  1. Sit at the edge of a chair with your feet flat on the floor.
  2. Without scrunching your toes tense the arch of the foot
  3. Aim to keep your heel and front foot in contact with the ground.
  4. Hold for 5 seconds arch clench

How to Exercises Toe Motion – YouTube

Barefoot Running Exercise: Foot Doming – YouTube

Seated Heel Raise

  1. Sit with your knee bent at 90 degrees, feet flat to the floor
  2. Spread your toes and slowly raise both heels off the ground to full height (control rising), keeping your toes and ball of the foot on the ground.
  3. Hold for 3 seconds then slowly lower to the ground.
  4. 15 repetitions x 3 Daily

Standing Calf Stretch

If you have tight calf muscles then stretching these will help reduce pressure on the front of the foot when walking.

  1. Facing the wall put both hands on the wall at shoulder height
  2. Place one foot in front of the other- feet facing forwards
  3. The front foot should be about 30cm from the wall
  4. Bend the front knee towards the wall until the calf in the back of the leg feels tight.
  5. Hold for 10 seconds
  6. Repetitions x15 x3 sets Daily

Seated Calf Stretch

If you prefer to stretch your calf muscles whilst seated, you can use a towel or a belt to stretch your calf muscle.

  1. Sit down with one leg outstretched and the other bent.
  2. Place a strap around the ball of your outstretched foot and hold the ends of the strap in your hands.
  3. Pull up against the strap until you feel a stretch at the back of your leg.
  4. Maintain the position and hold for 15 seconds.
  5. Repeat the above with your other leg.

Steroid Injections

Steroid injections can relieve inflammation in some patients which helps reduce the symptoms. There is a limitation on injections as can cause damage to the surrounding tissues with over-use.


Neuroma surgery is only recommended as a last resort, once non-operative treatment measures have been exhausted and if your symptoms remain significant. In most cases the operation is performed under a local anaesthetic. A neurectomy is surgery that involves the removal of the problematic nerve and then the surrounding tissues are often released.

There are risks to foot and ankle surgery

Off-work There will be a requirement to elevate your foot and rest non weight bearing then semi weight bearing.

Swelling and Stiffness- The foot can swell as a response to surgery and as part of the healing process. It can take up to six months for swelling to completely settle in some cases. Although in some cases post-surgery there may be increased stiffness in the foot.

Infection- The act of surgery is invasive which is also a risk to infection. In some cases, this can delay healing and will require antibiotic treatment.

Bloods Clots- A small risk of developing a blood clot after foot surgery. Following the pre and post operative advice will help reduce this risk.

Numbness- Can exist in the surgical site in the web space due to the removal of the nerve in this region.

Persistent Pain Some patients have persistent pain post-surgery or the symptoms may return. This can be because the nerve becomes problematic further in the foot.

Chronic Regional Pain Syndrome Surgery can sometimes result in a swollen, painful and highly sensitive foot. This can be challenging to manage and often patients will be referred to the pain clinic for support.


Criteria Based Access

In Bristol, North Somerset and South Gloucestershire neuroma surgery falls under the criteria-based access (CBA) Forefoot surgery policy. Therefore, you must have exhausted and evidenced the conservative treatment options available.  A consultation with a foot and ankle specialist can help discuss the treatment you have been doing and what further options are recommended. Funding for surgery will be considered if the problem is causing pain or severe functional impairment and treatment has been exhausted.

If you are struggling to manage your foot condition?

Contact your general practice if you need further help and guidance, a referral to local musculoskeletal services is required in some instances, and they can advise on appropriate treatment or pathways suitable to you.

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