I am often asked about pain in the ball of the foot. It is commonly described as a sharp, burning, shooting pain that shoots out the ends of the toes. It is very common in pregnant pregnant women whose feet begin to feel fatigued.
If you squeeze the ball of your foot together and it elicits pain and the shooting sensation your symptoms are consistent with what are called Neuromas. Neuromas are a common complaint in Podiatry.
Neuromas were once thought to be tumors, but have since been proven otherwise. Today, Neuromas are considered nerves that have become irritated and start to swell because of the irritation. Often they are irritated from neighboring “knuckle” bones being too close together. The bones alignment can be caused by a change in foot structure or function. this can also be the result of wearing high heeled or tight toed shoes. Fancy, narrow dress shoes or pointed elevated heels (which you often love when you put on but despise when you take off) can be the culprit. Relax! We all understand they are for looks, not function.
Slender fitting footwear crunch the foot bones together, squeezing the nerve that runs between the bones. This irritation leads to swelling of the nerve, making it prone to be irritated again in slim shoes. This starts a cycle of squeezing-irritating-swelling-squeezing, etc. Shoes aren’t the only ones to blame. Like many foot problems, mom and dad are to blame. Genetics can also result in either an abnormally large nerve or poorly-aligned foot bones that lay too close together.
Neuromas are diagnosed clinically by a quick foot exam. Xrays are generally taken to evaluate the alignment of the bones. Ultrasound (yep-not looking for baby’s gender) can also be used to view the nerve itself and see if it is enlarged.
Once diagnosed, Neuroma treatment can vary from simple shoe gear changes to surgery. If the offending stimulus to the nerve is caused from tight shoes the obvious answer is to change shoes. Shoes with a tight toe box should be switched to a more spacious and comfortable shoe (here are some options). Different taping and strapping techniques can also be implemented to conservatively offload the painful area. Anti-inflammatory pills such as Ibuprofen or Aleve may help reduce the inflammation to the area.
To quickly help patients get over neuroma pain, two options of injectable medicine are offered. The first is a corticosteroid injection that can reduce the amount of swelling and inflammation around the nerve. This, in the absence of bad shoes or genetics, stops the cycle mentioned above. The other injectable option is a series of alcohol injections. The series of 2-3 alcohol injections slowly “deaden” the nerve’s outer covering, inhibiting it’s sensation. So if you believe that getting drunk enough cures all problems, this may be the option for you! The goal is to not feel pain, by not feeling anything. The end result is the nerve is numb.
With this in mind, the surgical treatment for a neuroma is simple. You cut out the nerve. The good side being that the terrible burning pain is now gone. The down side to this is a loss of sensation to a small area between the toes. There is a small percentage of patients who report that the pain returns after some time. This is known as a “stump” neuroma, where the end of the cut nerve begins to be irritable.
Some podiatrists are trained in a less invasive surgery similar to the carpal tunnel surgeries done in the wrist. A small stab incision is made and a ligament between two bones is cut, releasing some pressure to the area. This is done endoscopically, and results seem to be less effective than removing the nerve.
So whether you want to cut it out or get it “drunk”, there are many options to treat neuromas. Discuss with your podiatrist which one is best for you.
As always, never self diagnose and always consult with your physician prior to any treatment.