Many conditions—including stress fractures, tendon inflammation, arthritis, and nerve damage—mimic the pain associated with a neuroma. Weight-bearing x-rays are often used to rule out fractures and arthritis. Once a neuroma diagnosis is confirmed, treatment will first consist of removing the source of the irritation and at least one cortisone anesthetic injection, which breaks up and thins the scar tissue surrounding the neuroma and reduces swelling. Physical therapy treatment for a neuroma may involve special shoe wear, neuromuscular reeducation, cold therapy, ultrasound, and manual therapy, which includes hands-on soft tissue massage, deep friction massage, manual strengthening, and joint mobilization. A physical therapist also may prescribe therapeutic exercises to stretch and strengthen the muscles surrounding the neuroma. Ultimately, a physical therapist will work to identify the cause of the neuroma and correct it, while providing education about neuroma prevention. It is important for individuals who have had a neuroma to gradually work back up to daily activities and sport performance. With physical therapy, anti-inflammatory medication, rest, cortisone injections, and foot-wear modifications, most people recover full foot functionality. Occasionally, though, decompression surgery may be necessary. A surgeon may need to cut the surrounding tissue in order to take the pressure off of the nerve. In rare cases, the surgeon may need to remove both the nerve and the neuroma.