As a general practitioner, I frequently encounter patients with nerve-related pain and discomfort in their hands and feet. One condition that deserves more attention is digital neuritis—an inflammation or irritation of the nerves supplying the fingers or toes.
While not as widely discussed as other neuropathies, digital neuritis can significantly impact daily life, work, and well-being. In this article, I’ll explore the causes, symptoms, treatment options, and what we know about its prevalence in Australia.
What Is Digital Neuritis?
Digital neuritis refers to inflammation or irritation of the digital nerves that supply sensation to the fingers or toes. This condition can affect both the upper and lower limbs but is most commonly discussed in the context of the toes, where it is often called a digital neuroma or, more specifically, Morton’s neuroma when it occurs between the toes of the foot.
Causes of Digital Neuritis
The most common cause of digital neuritis is nerve compression or entrapment. In the foot, this often occurs due to:
- Tight or ill-fitting footwear: Shoes that squeeze the toes or have a narrow toe box can compress the digital nerves, especially during prolonged standing or walking.
- Foot deformities: Conditions such as bunions, hammertoes, or flat feet can alter the foot’s mechanics, increasing pressure on the nerves.
- Repetitive trauma: Activities that involve repeated pressure or impact on the forefoot (e.g., running, dancing) can irritate the nerves over time.
- Obesity: Increased body weight can place additional stress on the feet, contributing to nerve compression.
- Occupational factors: Jobs requiring prolonged standing, walking, or using tight footwear (such as in hospitality or construction) can increase risk.
In the hands, digital neuritis may result from repetitive use, direct trauma, or underlying conditions such as carpal tunnel syndrome or rheumatoid arthritis.
Symptoms: What to Watch For
Digital neuritis typically presents with sensory symptoms in the affected finger or toe, including:
- Tingling or “pins and needles”
- Numbness
- Burning pain
- Sharp, shooting pain that may radiate along the nerve
- Increased sensitivity to touch or pressure
In the foot, patients often describe the sensation of “walking on a pebble” or feeling as if their sock is bunched up under the toes. Symptoms are frequently aggravated by activity and relieved by rest or by removing tight footwear.
How Common Is Digital Neuritis in Australia?
While there is limited data on digital neuritis specifically, we can look to statistics on Morton’s Neuroma—a common form of digital neuritis in the foot—for insight. A study of hospital admissions in Australia found:
- 13,579 hospital admissions for Morton’s neuroma between 1998 and 2008.
- The condition is three times more common in women than men, likely due to footwear choices and anatomical differences.
- The highest admission rate was in the 50–55-year-old age group, at 10.9 per 100,000 population.
These figures likely underestimate the true prevalence, as many cases are managed in primary care or do not require hospital admission.
Diagnosis
Diagnosis is primarily clinical, based on a detailed history and physical examination. Key steps include:
- History: Onset, duration, and character of symptoms; aggravating and relieving factors; occupational and footwear history.
- Examination: Palpation of the affected area may reproduce symptoms. In the foot, squeezing the forefoot may elicit a “Mulder’s click”—a palpable or audible click associated with Morton’s neuroma.
- Imaging: Ultrasound or MRI may confirm the diagnosis or rule out other causes, especially if symptoms are atypical or persistent.
Treatment Options
Conservative Management
Most cases of digital neuritis can be managed without surgery. Key strategies include:
- Footwear modification: Switch to shoes with a wide toe box, low heels, and good support to reduce nerve compression.
- Padding and orthotics: Custom insoles or pads can redistribute pressure away from the affected nerve.
- Activity modification: Reducing activities that cause aggravating symptoms, such as high-impact sports or prolonged standing.
- Manual therapy: Massage and stretching may help relieve nerve irritation.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help with pain and inflammation. In some cases, neuropathic pain medications (e.g., certain antidepressants or anticonvulsants) may be considered.
Injection Therapy
- Corticosteroid injections: These can reduce inflammation and provide temporary relief, especially in cases where conservative measures are insufficient.
- Alcohol sclerosing injections: Used less commonly, these aim to shrink the neuroma by causing local nerve destruction.
Surgical Intervention
Surgery is reserved for cases that do not respond to conservative or injection therapy. The procedure typically involves removing the affected nerve segment (neurectomy). While effective for many, surgery carries risks such as persistent numbness or neuroma recurrence.
Prognosis and Prevention
With early intervention and appropriate management, most patients experience significant improvement. However, chronic or severe cases may require ongoing care or surgical intervention.
Prevention tips include:
- Wearing well-fitted, supportive footwear
- Avoid prolonged use of high heels or narrow shoes
- Managing underlying conditions such as diabetes or arthritis
- Taking regular breaks from repetitive activities
When to See Your GP
If you experience persistent tingling, numbness, or pain in your fingers or toes—especially if symptoms interfere with daily activities—consult your GP. Early diagnosis and intervention can prevent progression and improve outcomes.
Final Thoughts
Digital neuritis, while often overlooked, is a significant cause of discomfort and disability for many Australians. As a GP, I aim to raise awareness of this condition, encourage early recognition, and promote effective, evidence-based management. By working together—patients, clinicians, and allied health professionals—we can reduce the burden of digital neuritis and help Australians stay active, healthy, and pain-free.
Dr Clem Bonney & Digital Neuritis
Dr. Clem Bonney is able to assist with the diagnosis and treatment of digital neuritis, a condition involving inflammation of the nerves. With a background in Occupational Medicine and patient-centred care, Dr. Bonney combines diagnostics with evidence-based therapies to help patients manage pain, restore function, and improve quality of life.