By Dr. Nicole Freels, FACAOM
When it comes to foot problems, this is especially true, considering that the average person walks 3,000 to 5,000 steps a day and exerts a force equal to two to three times one’s body weight with each step. How could your feet possibly heal themselves?
Nonetheless, I see patients every day who have suffered from foot pain for weeks, months and even years! One of the most common causes of this pain is a foot neuroma, or a thickened area of growth and inflammation around a nerve. Neuromas can occur anywhere in the body but in podiatry, we most often see them between the third and fourth toe.
A neuroma is the body’s way of protecting a nerve that has become damaged or injured.
The most common symptom is the sensation of having a rock in the shoe (when there is none) or having a bunched-up sock. Other patients say it feels like there is something inside the ball of their foot. Additional symptoms include:
• Tingling 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
The 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, the pain will become more intense and permanent nerve damage may occur.
Although we do not know exactly what causes neuromas, several factors may contribute to their development, including:
• Tight shoes
• High heels
• Abnormal positioning of the toes
• Hammertoes 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, I can diagnose a neuroma by listening to your 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 bone 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 should cause you to rethink this. At Lexington Podiatry, we have a great selection of fashionable shoes with a wider toe box and flat heels that can help reduce the pressure and compression of the nerve.
Medications: Depending upon the stage of the neuroma, I sometimes prescribe an oral anti-inflammatory medication. In other cases, an injection of cortisone or a local anesthetic may be required.
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 in-office procedure, we inject a solution of alcohol and anesthetic solution into the affected nerve which only takes a minute. 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 same day.
Success rate with chemical neurolysis is about 88 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.
If you have been suffering with foot pain, now is the time to take the first step to better foot health. Call the office (859) 264-1141 to schedule an appointment today.
2700 Old Rosebud Rd., #110
Lexington, KY 40509