Condition
Residual limb neuroma pain after amputation
Sharp, burning or tender pain at the end of a residual limb, often from a neuroma at a cut nerve end.
Medically reviewed by Efe Ozturk, DPM · Last reviewed
Watch: Residual limb neuroma pain explained
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A sharp, burning or shocking spot at the end of your residual limb? It may be a neuroma at a cut nerve end. Every nerve that supplied the lower leg and foot is cut when a limb is amputated. Each cut nerve tries to regrow. Without a target, the fibres tangle at the nerve’s end into a neuroma, which can be very painful and can make it hard to wear a prosthesis. In pooled studies, about 15 to 19 percent of people with a lower-limb amputation developed a symptomatic neuroma. In studies that followed people for at least three years the figure was about 30 percent, compared with 3 percent in shorter studies, so some neuromas take years to become symptomatic. A sharp, shocking, burning or tingling pain at or near the end of the residual limb. One very tender spot, with pain when it is pressed or tapped. Pain when the prosthesis presses on the area, or with certain movements. And pain that is separate from the phantom pain felt in the missing foot. Non-surgical care starts with prosthetic adjustments to relieve pressure, desensitization, medicines and injections. Surgery can remove the neuroma and bury the nerve end in muscle, which has long been the standard approach. Targeted muscle reinnervation connects the cut nerve to a nerve of a nearby muscle, so that it has somewhere to grow. A regenerative peripheral nerve interface wraps the nerve end in a small graft of muscle. In a randomized trial of 28 people, targeted muscle reinnervation improved phantom limb pain compared with excision and burying, and residual limb pain trended toward improvement. In a prospective study of 22 people, regenerative peripheral nerve interface surgery significantly improved residual limb pain. Across reviews, complication rates ranged from 13 to 31 percent, most often slow wound healing. Managing the nerve ends at the time of amputation may lower the chance of a symptomatic neuroma. If you have a tender, shocking spot in your residual limb, or pain that limits your prosthesis or your activity, an evaluation can help. To learn more, visit our website, or call the office to arrange a visit.
General education only; not a substitute for individual medical advice.
What a residual limb neuroma is
Every nerve that supplies the lower leg and foot is cut when a limb is amputated. Each cut nerve tries to regrow. Without a target, the fibres tangle at the nerve’s end and form a neuroma. A neuroma can be very painful and debilitating, may prevent prosthesis use, reduce quality of life and require medication.[1] This page focuses on neuromas after amputation. For neuromas in a limb that remains whole, see painful neuroma of the foot, ankle and leg. For the broader picture of pain after amputation, see pain after leg amputation.
How common it is
Reports vary because neuromas are often not recognized:
- A meta-analysis of studies published between 2000 and 2020 estimated a 59% prevalence of residual limb pain and a 15% prevalence of symptomatic neuroma after lower-extremity amputation.[1]
- A meta-analysis of 1,329 lower-limb amputees found symptomatic neuromas in 19% overall. In studies with at least three years of follow-up the figure was 30%, versus 3% with shorter follow-up. That suggests some neuromas take years to become symptomatic.[2]
- After amputation for poor circulation, a single study reported a 5% incidence.[6]
Symptoms
- a sharp, shocking, burning or tingling pain at or near the end of the residual limb
- one very tender spot, and pain when it is pressed or tapped
- pain that appears when the prosthesis presses on the area, or with certain movements
- pain that is separate from the “phantom” pain felt in the missing foot
How it is evaluated
An evaluation includes an examination of the residual limb, looking for a point that reproduces the pain when it is tapped. Ultrasound or MRI can help show the neuroma. A small anaesthetic injection near the suspected nerve that temporarily eases the pain can help confirm that the nerve is the source. These tests are arranged with another specialist. Your prosthetist is an important partner, because the socket can add to the pressure on a neuroma.
Non-surgical treatment
- prosthetic adjustments to relieve pressure over the nerve
- desensitization therapy for the skin
- medicines for nerve pain, prescribed by your physician
- injections around the nerve
Surgical treatment
When non-surgical care doesn’t help enough, surgery targets the nerve directly.
- Neuroma excision with burying. The neuroma is removed and the nerve end is moved into a quieter place, such as muscle. This has long been the standard approach.[7]
- Targeted muscle reinnervation (TMR). The cut nerve is connected to a nearby motor nerve of a muscle, so that it has somewhere to grow. See targeted muscle reinnervation.
- Regenerative peripheral nerve interface (RPNI). The nerve end is wrapped in a small graft of muscle. See regenerative peripheral nerve interface.
- Nerve reconstruction with a graft, when the nerve can be reconnected. See nerve grafting.
In a randomized trial of 28 people with chronic pain after amputation, targeted muscle reinnervation improved phantom limb pain compared with excision and burying, and residual limb pain trended toward improvement.[7] In a review of 11 studies of targeted muscle reinnervation in 318 lower-limb amputees, treatment reduced phantom and residual limb pain with limited complications; a neuroma developed after the operation in 7.2%.[8] In a prospective study of 22 people with lower-limb amputation who had regenerative peripheral nerve interface surgery for chronic pain, residual limb pain improved significantly, while phantom limb pain decreased modestly and function was not lost.[9]
Risks and limits
Any operation on a residual limb carries the risks of infection, wound-healing problems and the need for more surgery. Across reviews of these two procedures, complication rates ranged from 13% to 31%, most often slow wound healing.[4] Nerve surgery may not remove all pain. Most reports come from small studies, and the techniques are still being compared.
Prevention
Nerve ends can be managed when the amputation is done. In a comparison of 105 limbs, a symptomatic neuroma recurred in 19% of limbs that had delayed targeted muscle reinnervation, compared with 1% of limbs that had it at the time of amputation.[5]
When to seek care
Consider an evaluation if you have a tender, shocking spot in your residual limb, or pain that limits your prosthesis or your activity.
References
- 1.List EB, Krijgh DD, Martin E, Coert JH. Prevalence of residual limb pain and symptomatic neuromas after lower extremity amputation: a systematic review and meta-analysis. Pain. 2021;162(7):1906-1913. PubMed 33470746 (external site)
- 2.Huang YJ, Assi PE, Drolet BC, Al Kassis S, Bastas G, Chaker S, et al. A Systematic Review and Meta-analysis on the Incidence of Patients With Lower-Limb Amputations Who Developed Symptomatic Neuromata in the Residual Limb. Ann Plast Surg. 2022;88(5):574-580. PubMed 34270470 (external site)
- 3.Langeveld M, Hundepool CA, Duraku LS, Power DM, Rajaratnam V, Zuidam JM. Surgical Treatment of Peripheral Nerve Neuromas: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2022;150(4):823e-834e. PubMed 35895004 (external site)
- 4.Mauch JT, Kao DS, Friedly JL, Liu Y. Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic review. PM R. 2023;15(11):1457-1465. PubMed 36965013 (external site)
- 5.Goodyear EG, O'Brien AL, West JM, Huayllani MT, Huffman AC, Souza JM, et al. Targeted Muscle Reinnervation at the Time of Amputation Decreases Recurrent Symptomatic Neuroma Formation. Plast Reconstr Surg. 2024;153(1):154-163. PubMed 37199690 (external site)
- 6.Langeveld M, Bosman R, Hundepool CA, Duraku LS, McGhee C, Zuidam JM, et al. Phantom Limb Pain and Painful Neuroma After Dysvascular Lower-Extremity Amputation: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg. 2024;58(2):142-150. PubMed 37616476 (external site)
- 7.Dumanian GA, Potter BK, Mioton LM, Ko JH, Cheesborough JE, Souza JM, et al. Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial. Ann Surg. 2019;270(2):238-246. PubMed 30371518 (external site)
- 8.Berger LE, Shin S, Haffner ZK, Huffman SS, Spoer DL, Sayyed AA, et al. The application of targeted muscle reinnervation in lower extremity amputations: A systematic review. Microsurgery. 2023;43(7):736-747. PubMed 36864779 (external site)
- 9.Lee JC, Kubiak CA, Best CSW, Hamill JB, Ki J, Kim HM, et al. Regenerative Peripheral Nerve Interface Surgery to Treat Chronic Postamputation Pain: A Prospective Study in Major Lower Limb Amputation Patients. Ann Surg Open. 2025;6(1):e535. PubMed 40134500 (external site)
This page is general health information and isn’t a substitute for advice from a clinician who knows your history. Read our medical disclaimer and how we review content.
Related topics
Condition
After leg amputation
Phantom limb pain and residual limb pain after leg amputation, and how neuromas and nerve surgery fit in.
Condition
Phantom limb pain
Pain that seems to come from an amputated foot or leg, and the treatments that have been studied.
Treatment
Targeted muscle reinnervation
A nerve-transfer operation that connects a cut nerve to a muscle, used to treat or prevent painful neuromas after amputation.
Treatment
Regenerative peripheral nerve interface
Wrapping a cut nerve end in a small muscle graft so it has a target to grow into, to prevent or treat neuroma pain.