By Brian K. Bailey, DPM – Body-Mind-Spirit Podiatric Center
No less an expert than Leonardo da Vinci recognized the human foot as “a masterpiece of engineering and a work of art.” Think about it. The average person walks between 3,000 and 5,000 steps a day, exerting a force equal to two to three times their body weight with each step!
So it’s not uncommon for people to experience problems with their feet. Soreness and tiredness are universal and often go away with rest, elevation, a little bit of ice or an over-the-counter pain reliever.
But pain in the foot – burning, numbness, tingling – is not normal and needs to be checked out by a healthcare professional. There are any number of problems that can cause foot pain, but one of the most common issues is Morton’s Neuroma.
Morton’s Neuroma occurs when one of the nerves that runs between the long bones of the foot becomes irritated and inflamed. Most commonly, Morton’s Neuroma involves the nerve between the third and fourth toe, although others may be affected. It is rare, although not unheard of, for a patient to have more than one neuroma in a foot at once.
Symptoms of Morton’s Neuroma include:
• Tingling in the space between the third and fourth toes
• Toe cramping
• Sharp, shooting, or burning pain in the ball of the foot and sometimes toes
• Pain that increases when wearing shoes or applying pressure to the affected area
Patients often report a sensation that there is a rock in the shoe, something in the ball of the foot, or that the sock has bunched up at the toe.
Symptoms develop gradually over time and may only occur occasionally, such as when wearing a certain pair of shoes or doing a certain activity. In the early stages of development, patients may be able to relieve the pain by removing the shoe and massaging the affected area. Without treatment, the neuroma will continue to grow and the pain will become more intense. Permanent nerve damage may occur.
What causes Morton’s Neuroma?
Although we do not know exactly what causes the condition, several factors may contribute to its development, including:
• Tight shoes
• High heels
• Abnormal positioning of the toes
• Hammer toes and bunions
• High foot arches
Additionally, runners and tennis/racquetball players are at increased risk. Not surprisingly, women are five times more likely to develop a neuroma than men are.
Diagnosis and Treatment
In many cases, a neuroma can be diagnosed simply by listening to symptoms and examining the foot. Despite the ease of diagnosis, an X-ray is usually in order to ensure there are no other problems, such as arthritis or an infection. Initially, we will work to reduce the aggravation of the nerve through:
Padding and Taping: Padding and taping the toe area provides support for the metatarsal arch, which lessens the pressure on the nerve and decreases the amount of compression during walking.
Icing: Icing helps reduce swelling, which can aggravate the nerve.
Orthotic Devices: Custom shoe inserts can provide support to the foot, reducing the pressure and compression on the affected nerve.
Changing Footwear: While women, in particular, love a cute shoe, the pain of a neuroma will often cause them to rethink this. Those suffering with a Morton’s Neuroma will be well served by selecting shoes with a wider toe box and flat heels to reduce the pressure and compression of the nerve. Selecting exercise shoes that provide plenty of support while not restricting the foot is extremely important.
Medications: Depending upon the stage of the neuroma, an oral anti-inflammatory medication may be of help. In other cases, an injection of cortisone or a local anesthetic may be required.
About 25 percent of patients find relief from Morton’s Neuroma from these simple steps.
More Aggressive Treatment
In some cases, it is necessary to destroy the nerve that is causing the pain, either surgically or through a series of injections, called chemical neurolysis.
An office procedure, chemical neurolysis involves injecting a solution of alcohol and anesthetic into the affected nerve. This destroys the nerve with few or no complications, activity restrictions or recovery time. Some patients report minor pain in the evening after the injection, but most say it is far less than that caused by the neuroma. Patients are typically back to work and their normal activities the next day.
Our success rate with chemical neurolysis is 95 percent; a result that is comparable to, if not better than, the surgical option. Patients who have had chemical neurolysis are happy to be free of pain and wish they had sought help earlier.
Brian K. Bailey, D.P.M., is a podiatrist with Body-Mind-Spirit Podiatric Center in Ashland, Ky. The office is located at 500 14th Street, at the intersection with Central Avenue. New patients are welcome. For more information, please call the office at (606) 324-FOOT (3668).
Dr. Brian K. Bailey is a Podiatric Physician & Surgeon with a private practice located in Ashland, KY. He is also a Clinical Professor of Podiatric Medicine & Surgery at Pikeville College of Osteopathic Medicine and a Personal Wellness Coach & Fitness Trainer. Dr. Bailey has written several books, including: Secrets to Happiness, Inner Peace and Health, Metabolic Syndrome 2011, Nutrients for Prostate Cancer Prevention and Eradication, Breast Cancer Prevention and Wholistic Treatment, and Prostate Cancer Prevention and Wholistic Treatment.
Body-Mind-Spirit Podiatric Center
500 14th Street, Ashland, Kentucky, 41101
Phone (606) 324-FOOT