You may be suffering from an inflamed nerve called a neuroma. A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth toes that brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot. Keep in mind it can occur to any of your toes, the 3rd and 4th toes are just the most common.
The principal symptom associated with a neuroma is pain between the toes while walking. Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing or massaging the affected area. Personally, my Mom used to always rub her toes and ball of her foot trying to “work” the pain out. At times, she would describe the pain as similar to having a stone in her shoe. The vast majority of people who develop neuromas are women. This is because many of them love to wear high heels. Which are bad…bad…bad!!!
I don’t know if I have a neuroma, now what? OK, let’s break it down, do you suffer from any of the following symptoms?
Pain in the forefoot and between the toes.
Tingling and numbness in the ball of the foot.
Swelling between the toes.
Pain in the ball of the foot when weight is placed on it.
What did I do to get this?
No one knows, however, a number of factors can contribute to the formation of a neuroma.
Biomechanical deformities, such as a high-arched foot, or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition. Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve. Improper footwear that causes the toes to be squeezed together is problematic. Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.
Don’t worry, you don’t have to throw out your high heels. I wear my heels on occassion. On an occassion where I know I’m going to be sitting the majority of the time. I have in my office silicone pads that you can put under the ball of the foot to help cushion the area when walking.
Repeated stress, (ie, Toyota, Hospital, Lexmark and Keeneland employees) can create or aggravate a neuroma. It’s caused by a combination of factors that include walking on concrete all day, and the foot shape you were born with. As you will read below I can fabricate a custom insert for your shoe to re-create a soft surface such as grass, even when you’re walking on concrete. I’ve found patients love how this makes their feet feel, especially when standing next to their co-worker who’s constantly complaining about their feet. Be nice, pass this information on to those in need. =)
Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is key to avoid surgical correction. Call my office for an evaluation at the first sign of pain or discomfort; if left untreated, neuromas tend to get worse. Much, much worse. So, don’t wait.
The primary goal of most of my early treatment regimens is to relieve pressure on areas where a neuroma develops.
On your first visit in my office an x-ray is obtained to ensure that there are no additional conditions present. Once diagnosed with a “pinched nerve”, treatment begins.
The first and easiest treatment is Padding and Taping: Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma. Next, Medication: I routinely prescribe an anti-inflammatory to ease acute pain and inflammation caused by the neuroma.
An essential component to getting rid of your neuroma is a custom insert for your shoe, called an orthotic. This is an insert that is specific for your particular foot shape, this is a prescription for you. No one else can put this in their shoe. Consider it similar to a pair of glasses. It’s an accessory, but a necessary accessory. Many people after wearing their custom insert can no longer walk comfortable without it. It’s addictive! Generally you want to change them about once a year as our feet change, with children, dependent on how fast they grow, maybe every 6 months. Their are many techniques to get an orthotic fabricated. The majority of my patients use a gait scan.
What is a gait scan? This is computer generated image that is obtained when you walk across this screen, it creates a 3-D image of your foot showing pressure points. It also can tell me to a tenth of a percentage if you have one limb longer or shorter than the other. Many people that suffer with knee, hip and back pain have structually one leg longer than the other. So, the rest of their body is compensating, they’re entirely out of whack. Also, many patients that have had trauma to their feet/ankles, had knee/hip/back surgery have a limb length discrepancy which can easily be balanced out with an insert for their shoe.
I also offer an over the counter insert, called Powersteps (different from what is sold in stores) to those who may not need a custom insert. Don’t waste your money at the big chain retailers, these can only be ordered by medical clinicians.
During your first visit, we review the above information and if you are suffering from intense pain from this condition, a steroid injection is offered. I know, who wants an injection to their foot? I’m just giving you the facts. This injection feels like a bee sting and provides immediate relief. (Side note: when performing any injection in my office cold spray is used to numb the skin before the needle is introduced to decrease the discomfort). Many patients are very thankful for this. If the neuroma pain persists the next option discussed is referred to as alcohol sclerosing injection. This is routinely administered to the neuroma in the office. This is issued as many as 7 times (if need be to avoid surgery). This process slowly “kills” the nerve. Killing the nerve, kills your symptoms. Thus, mission accomplished!
If all else fails…
Surgical Options: When early treatments fail and the neuroma progresses past the threshold for such options, surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis under mild sedation, with a recovery time that is often just a few weeks. It you reach this point, we will discuss this option thoroughly, describing the surgical procedures to be used and the results you can expect.
Your Feet Aren’t Supposed to Hurt
Remember that foot pain is not normal, and any disruption in foot function limits your freedom and mobility.
If you believe you are suffering from a neuroma, please give me a call to schedule an appointment (859) 264-1141, or visit our website at www.lexpodiatry.com to make an appointment today. We look forward to getting you back on your feet!