Painful point
There is a spot on the stump, touching which causes sharp pain.
CONDITION / ARMS AND LEGS
Stump neuroma.
Stump neuroma is a painful thickening at the end of a nerve cut during amputation. It causes a painful spot, pain from touch or pressure from the prosthetic socket, and may interfere with wearing the prosthesis. Treatment starts with the prosthetic socket, medications, and injections; if pain persists, the neuroma is excised and the nerve is transferred to the muscle.
CONCEPTUAL VISUALIZATION- What it is
- Painful thickening at the end of a cut nerve in the stump.
- How common
- According to meta-analyses — in 15% of people after leg amputation and in 22% after arm amputation.
- The main feature
- Painful spot on the stump: pain from touch, tapping, or pressure from the prosthetic socket.
- Who treats it
- Pain without surgery — a pain doctor; surgery — a plastic surgeon together with a prosthetist.
01 / WHAT IS ITWhat is
What is
Stump neuroma.
During an amputation, nerves are inevitably cut. The end of the nerve then tries to grow further, but has nowhere to go: the fibers grow chaotically and form a small knot — a neuroma. This is a normal part of nerve recovery after injury.
Not every neuroma hurts. It becomes a problem when it lies where the socket presses on it, or is irritated by movement and touch. Then doctors talk about a symptomatic, that is, painful, neuroma. It can interfere with wearing a prosthesis, worsen quality of life, and require taking medication.
A neuroma is just one cause of pain in the stump. Pain can also occur due to friction or rubbing from the socket, scars, or bone under thin skin. Separately, there can be phantom pain — in a limb that no longer exists. The treatment depends on what exactly hurts.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
Stump neuroma presents.
Pain from a neuroma is associated with a specific nerve and a specific spot on the stump. The signs that people most often report:
Pain from the socket
It hurts when the socket presses on this point; the prosthesis has to be removed or worn less.
Problematic stump"Electric shock"
Pain shoots, burns, or stabs — doctors call such pain nerve pain, or neuropathic pain.
Tapping
If you lightly tap on the nerve spot, tingling or shooting pain appears along it.
Cold
The stump poorly tolerates cold — pain increases.
Pain in the missing limb
Alongside, there can also be phantom pain: it feels as if the lost hand or foot hurts.
Phantom pain03 / REASONSWhy is it formed?
Why is it formed?
neuroma.
A neuroma forms from the end of a cut nerve. How often it hurts has been assessed by two meta-analyses:
Severed nerve
After injury, the nerve regenerates irregularly or incompletely — this leads to the formation of a neuroma.
Leg amputation
Painful neuroma — in 15% of people, stump pain for any reason — in 59%.
Lower limb amputationHand amputation
Painful neuroma — in 22%, stump pain for any reason — in 58%.
Upper limb amputationSize is not the main factor
In an ultrasound study of 80 patients, among 159 neuromas found, 53 were painless; pain did not depend on the size of the neuroma, age, or duration of the amputation.
Other causes of pain
Friction and wounds from the prosthetic socket, scars, bone under thin skin also cause stump pain — they must be distinguished from a neuroma.
Problematic stump
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
An old neuroma usually does not require emergency care: this is a planned consultation. Urgent action is needed if signs of blood infection or a clot appear after amputation or surgery on the stump.
103 immediately if:
- breathing became very frequent;
- confusion, unclear speech, the person talks nonsense;
- skin, lips, or tongue are blue, pale, or blotchy;
- very high or very low temperature, chills;
- a rash that does not fade when pressed;
- it suddenly became difficult to breathe;
- pain in the chest or upper back;
- the heart beats very often;
- the person fainted.
Do not delay a visit to the doctor:
Immediately - to the surgeon who operated, and if it does not work - to the reception department: after a recent stump surgery, pain or swelling increases rapidly. On the same day: stump skin is hot, red, and painful; fluid or pus comes from the wound or skin; swelling of the stump increases; a pulsating pain and swelling appear in one leg or arm (possible clot); coughing up blood. Planned: painful spot on the stump, pain from the socket, shooting pain that makes it difficult to wear the prosthesis.
05 / DIAGNOSTICSHow to find
How to find
painful neuroma.
- Conversation
When and at what level the amputation was, exactly where it hurts, what kind of pain it is, whether medications and injections helped, how the prosthesis behaves.
- Stump examination
The doctor searches for the painful point, taps along the nerve, examines the skin, scars, and places where the socket presses.
- Test injection
A local anesthetic is injected near the suspicious nerve: if the pain disappears temporarily, the source is most likely found.
- ultrasound or MRI
Ultrasound shows the neuroma and its connection to the nerve and helps distinguish a painful neuroma from a non-painful one; MRI — if needed.
- Together with the prosthetist
They evaluate the socket: whether it presses on the neuroma and what to change in the prosthesis.
06 / TREATMENTHow we treat
How we treat
Stump neuroma.
There is no single universally accepted method: treatment is selected based on the cause of the pain, the location of the neuroma, and plans regarding the prosthesis.
01
Without surgery
This is usually where they start.
- Socket fitting
- The prosthetist adjusts the socket so that it does not press on the painful spot.
- Medicines for nerve pain
- Anticonvulsants (pregabalin, gabapentin) or antidepressants (amitriptyline, nortriptyline) that act on nerve pain; prescribed by a doctor.
- Injections
- A corticosteroid or local anesthetic is injected into the neuroma; ultrasound helps to target it accurately.
- Other procedures
- A pain doctor may suggest chemical nerve destruction, freezing (cryoablation), or radiofrequency ablation.
02
Surgery
If the pain persists despite treatment.
- Excision of the neuroma
- The neuroma is removed, and the end of the nerve is either embedded into the surrounding tissues or covered with a cap. According to a meta-analysis of 54 articles on painful limb neuromas, the surgery was effective on average in 77% of patients; no advantages of one method over another were identified, although the outcomes in the studies were evaluated differently.
- TMR
- After excising the neuroma, the nerve is sutured to a motor branch of the muscle of the stump. In a randomized study of 28 patients, TMR reduced phantom pain more than excision with muscle implantation; for stump pain, the difference was not statistically significant.
- RPNI
- The end of the nerve is wrapped with a small piece of the patient's own muscle. There are fewer studies on RPNI so far: in a review — 3 studies, 75 patients.
- What to expect
- In a review of 17 studies, TMR and RPNI reduced neuroma pain in at least 75% of patients in different studies. Complications occurred in 13–31% depending on the study, most often delayed wound healing.
03
Prevention
If the amputation is only planned.
- TMR or RPNI during amputation
- Nerves are immediately redirected to the muscles to reduce the risk of neuromas and phantom pain.
- What is known
- In comparative cohort studies (196 patients) after preventive RPNI, none of the 97 patients had painful neuromas compared to 20 out of 99 without it. The authors assess the reliability of these data as low or very low.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Stump neuroma at the Dr. Valikhnovskyi Institute of Surgery is treated in the 'Bionic Limb Prostheses' direction. The clinic performs the surgical part — neuroma excision, TMR or RPNI, stump reconstruction. Medications and pain procedures are managed by a pain doctor, and a prosthetist-partner selects the socket and prosthesis.
CLINIC SERVICE
Bionic limb prostheses
Preparing the stump for a modern prosthesis: less phantom pain, clearer signals, attachment to the bone.
View service
What we do for this condition
- Neuroma excision with TMR — the neuroma is excised, and the nerve is redirected to a motor branch of the stump muscle to reduce the risk of the neuroma forming again.
- RPNI — the nerve end is wrapped with a small piece of muscle; the nerve grows into it, and the risk of neuroma decreases.
- Prevention during amputation — if the amputation is ahead, TMR or RPNI can be performed during the surgery itself.
- Stump reconstruction — if pain is also caused by scars or bone under thin skin: scars are excised, bone is covered with full tissues, if necessary — with flaps.
- Together with the prosthetist — evaluation of the stump, pain, and muscle signals before surgery, setting up the prosthesis, and training afterward.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photos and extracts onlineSend a photo of the stump, discharge summaries, and X-rays if available — the doctor will preliminarily assess the situation.
- ConsultationExamination of the stump, searching for painful points, assessment of the socket and previous treatment; if necessary — ultrasound.
- PlanWhether surgery is needed at all, which method to choose, and what to do with the prosthesis — together with the prosthetist.
- SurgeryExcision of the neuroma with TMR or RPNI; if necessary — together with stump reconstruction.
- RecoveryWound healing, dressings, pain control; nerves grow into muscles for months, the prosthesis is returned according to the plan.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Does a neuroma always hurt?
No. In an ultrasound study of 80 patients with 159 neuromas, 53 were not painful, and the pain did not depend on the size of the neuroma. Therefore, it is important to find the one that is painful.
How to understand that it is the neuroma that actually hurts?
The diagnosis is made through conversation and examination: a painful point at the nerve site, tingling when tapped, relief after a trial injection of painkiller, confirmation by ultrasound or MRI.
Is it possible to do without surgery?
Sometimes, yes. They start by fitting a socket, medications for nerve pain, and injections. If the pain persists, surgery is discussed.
Will the neuroma form again?
To reduce this risk, the end of the nerve is not left free: it is transferred to a muscle (TMR) or wrapped in muscle (RPNI). In a review of 39 articles, neuroma symptoms occurred less frequently after TMR.
Will surgery help with phantom pain?
It may help. In a review of 17 studies, after TMR or RPNI, phantom pain decreased in 45–80% of patients depending on the study — that is, not in all patients.
When can a prosthesis be worn after surgery?
The timing depends on the extent of the surgery and wound healing. The exact plan is made by the doctor together with the prosthetist.
Amputation is still ahead. Is it possible to prevent a neuroma?
Yes, TMR or RPNI can be performed during the amputation itself. The data are encouraging but mostly come from small observational studies.
Sources
16 sources · meta-analyses, systematic reviews, randomized study, and NHSshowCollapse
- Prevalence of residual limb pain and symptomatic neuromas after lower extremity amputation: a systematic review and meta-analysisPain, 2021doi:10.1097/j.pain.0000000000002202 ↗
- Prevalence of residual limb pain and neuromas after upper extremity amputation: a systematic review and meta-analysisJournal of Hand Surgery (European Volume), 2025doi:10.1177/17531934251345368 ↗
- Diagnostic Criteria for Symptomatic NeuromaAnnals of Plastic Surgery, 2019doi:10.1097/SAP.0000000000001796 ↗
- Neuromas as the cause of pain in the residual limbs of amputees. An ultrasound studyClinical Radiology, 2016doi:10.1016/j.crad.2016.05.022 ↗
- Painful neuromasThe Clinical Journal of Pain, 2012doi:10.1097/AJP.0b013e31823d30a2 ↗
- Surgical interventions for the treatment of painful neuroma: a comparative meta-analysisPain, 2018doi:10.1097/j.pain.0000000000001101 ↗
- Traditional Neuroma Management Strategies: A Systematic ReviewAnnals of Plastic Surgery, 2023doi:10.1097/SAP.0000000000003342 ↗
- Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical TrialAnnals of Surgery, 2019doi:10.1097/SLA.0000000000003088 ↗
- Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic reviewPM&R, 2023doi:10.1002/pmrj.12972 ↗
- Pain and Functional Outcomes following Targeted Muscle Reinnervation: A Systematic ReviewPlastic and Reconstructive Surgery, 2024doi:10.1097/PRS.0000000000010598 ↗
- Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces Versus Standard Management in the Treatment of Limb Amputation: A Systematic Review and Meta-AnalysisPlastic Surgery, 2024doi:10.1177/22925503221107462 ↗
- Prophylactic Regenerative Peripheral Nerve Interfaces for Prevention of Postamputation Pain: A Systematic Review and Meta-Analysis of Comparative Clinical StudiesJournal of Clinical Medicine, 2026doi:10.3390/jcm15155959 ↗
- AmputationNHS, 2023nhs.uk/tests-and-treatments/amputation ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- DVT (deep vein thrombosis)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
The figures on the page are from these sources.
The stump hurts
Does it interfere with the prosthesis?
Send photos of the stump, discharge summaries, and scans. The doctor will say whether it looks like a neuroma and what can be done — with surgery or without.