There are lots of reasons for developing foot pain and a lot of them we can help with.
You may have referral of pain from radiculopathy (irritation of the sciatic nerve as it leaves your spinal cord in the lumbar spine) or one of the joints in your foot may be sprained or you could have irritated ligaments, tendons or muscles or be developing arthritis in one of your foot joints.
Another common cause of pain, particularly when you put your foot into a shoe and when walking, is a neuroma.
What is it?
Something called Morton’s Neuroma – also called Morton’s metatarsalgia, Morton’s neuralgia, plantar neuroma and intermetatarsal neuroma – is a small benign growth of tissue on a nerve – the common digital plantar nerve, due to ischaemic (lack of oxygen) inflammation of the nerve that supplies your third and fourth toes. Compression of the nerve and/or trauma entrap the nerve just before it splits to supply your third and fourth toes.
When the nerve is compressed, the blood supply is reduced to the nerve and this means that the nerve cannot transmit nerve supply adequately to the toes. If this becomes severe, the covering of the nerve can become damaged (demyelination) and fibrotic scarring can develop within the nerve. If this scarring gets larger it is obviously going to take up even more room in the small area through which the nerve passes and will add to the compression on the nerve.
We need to treat you before the demyelination occurs as it is this that is thought to be the cause of pain. Therefore it is better to seek treatment before you have suffered pain for too long then treatment is more likely to correct the cause of the neuroma and it may not become so bad that it needs surgery.
What Does It Feel Like?
You can feel like a knife is going up between the third and fourth toes on the pad of your foot as you bend your foot to push off when you walk or you can feel numbish pins and needles in the ball of your foot in the region of the third or fourth toes. It is suggested that the position of the nerve means that when you walk, it is pushed and compressed against the front of a ligament during the push off phase of walking.
Do You Need Surgery To Remove It?
I often discuss the need for surgery or otherwise in my posts. Do you need surgery on a Morton’s Neuroma or could we help you at the clinic?
Not necessarily is the answer. I have treated many people with this condition over the years and some respond well to treatment and some need either an injection of corticosteroid to shrink the neuroma and some people need surgery to remove the neuroma.
I had one of these years ago. It is in fact much more common in women – maybe because we wear high heeled shoes. However, bunions, hammer toe or splay foot can also predispose you to developing a neuroma.
I had pain for ages on and off before I tried massage, mobilisation, stretching, therapeutic ultrasound, exercises and avoiding wearing tight shoes. All of these things helped for a while but ultimately I couldn’t walk well in shoes because of the pain every time I pushed off. I started to look silly wearing boots in summer as they were the only things that didn’t put pressure on the sides of my foot and irritate the nerve.
How Might We Help?
The aim of mobilising, massaging and stretching is to open up the space between the bones — the metatarsals — in the ball of the foot, which will increase circulation, which can help promote healing.
Most importantly, we need to watch how you walk. If you twist the foot a lot you can place pressure on the nerve and that can lead to the development of a neuroma. Twisting the foot can be due to weakness in the main muscles of the buttocks or hips or stiffness in the hips. We need to observe all of the patterns of walking to see if we can find where the irritation is actually coming from. If we can correct that then you will walk with greater stability and less twisting and that can give the nerve a chance to recover and the neuroma may then shrink naturally.
You can try an ice pack. Ice packs can reduce inflammation. If you tend to wear tight and particularly high heeled shoes all day, you should think about reducing the amount of time you do so. If you must wear high heels on occasion, wedges or platforms may be better for your feet. Pads or cushioned inserts are also available to place in your shoes under the ball of your foot to help lift and separate the metatarsals.
Orthotics may help as they help to correct the way your foot articulates.
The most important thing is to get the right diagnosis.
At the clinic we will palpate the area and it is possible to feel a small piece of tissue, the size of a pea at the area of the nerve between the third and fourth toes.
If we are not sure and treatment is not helping, an ultrasound scan will show us the size of the neuroma. X-rays will not be helpful as this is soft tissue.
What If Treatment Doesn’t Help?
If after a few treatments and you trying exercises at home and avoiding wearing tight, high heeled shoes, you are not responding, we will refer you to a foot specialist for either a corticosteroid injection or surgery.
I had surgery 30 years ago for a very stubborn neuroma and it was the best thing I did but I had tried a lot of treatment before I chose that route. Any surgery should really be a last resort. Things can go wrong and will not necessarily relieve your pain so it is well worth giving manual therapy a go.
If you have pain when you walk then do come and talk to us about it – we don’t just treat backs you know!