Q: I am a mid-sixties woman of average size. Ten months ago my podiatrist gave me shots for Morton’s neuromas to treat my painful arches and the soles of my feet. I felt some relief but it was short-lived. I am being treated by a chiropractor by using an activator on the arches and soles. I usually feel some relief the second day after the treatment but the discomfort always comes back.
I use orthotics for the arch support and the soles of the feet and also a gel pad for the metatarsal area. I have discomfort whether or not I use the gel pad. So how can I get rid of the pain in the soles of my feet?
A: Morton’s neuroma affects the ball of the foot, commonly in the third webspace, but it can be in the 2nd or fourth metatarsal spaces. Symptoms may include pain, a numb feeling, a burning sensation that radiates into the toes, and a feeling you are trying to wall with a pebble in your shoe.
The condition may be from an injury, pressure, or irritation that results in a gradual thickening of the nerve tissue leading to the affected toes. Those at an increased risk for Morton’s neuroma are those people with flat feet, hammertoes, bunions or other foot abnormalities, and those who participate in repetitive athletic activities such as running and jogging that put added stress on the feet. Shoes are commonly to blame – from wearing high heels, special tight-fitting footwear such as down-hill ski boots, and other footwear that does not either fit properly or provide sufficient support.
In an attempt to determine the diagnosis, a general practitioner or podiatrist (foot doctor) might choose to order an MRI or ultrasound test that can reveal a soft tissue abnormality. Interestingly, an MRI performed for diagnostic purposes can be problematic since 30% of people without Morton’s neuroma have findings that resemble the neuroma but are not, leading to an incorrect diagnosis.
A logical first step is to wear or purchase footwear that fits well, followed by the purchase of foot pads or arch supports for your shoes that will relieve pressure on the nerve. Over-the-counter anti-inflammatory ibuprofen and aspirin might reduce the swelling present and reduce or relieve the pain. The application of an ice pack (or a bag of frozen peas or corn) wrapped in a light towel applied to the affected area periodically throughout the day might be tried. When the contributory cause of the pain is known (strenuous activity, ill fitting shoes, or other causes), discontinuation of the activity on a temporary basis is encouraged. When this fails to provide adequate relief, steroids injected into the top of the foot may be appropriate. A procedure known as cryogenic neuroablation can expose the affected nerve to very cold temperatures, interfering with the transmission of pain signals. This technique is relatively new, has been performed by some podiatrists, is minimally invasive and considered safe. Unfortunately, this is not a permanent fix and the symptoms will return. Through another procedure known as surgical decompression, pressure on the nerve can be relieved. Lastly, removal of the nerve can be accomplished through surgery. While successful, this procedure can result in permanent numbness of the affected toes and is therefore not always ideal.
If you aren’t obtaining satisfactory results, I recommend you request a referral to a top notch podiatrist in your area who may have other suggestions to offer.
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