Nerve Pain

A Podiatrist’s Approach to Neuromas and Nerve Entrapment

Nerve pain in the foot can manifest as sharp, burning sensations, tingling, numbness, or shooting pains that can make walking miserable. This discomfort is often caused by a nerve that is compressed, irritated, or damaged. One of the most common causes of localized nerve pain in the foot is a condition known as Morton’s Neuroma.

At City Orthopaedics & Sports Medicine, our podiatry team, including Dr. Jason Hymowitz, specializes in accurately diagnosing the source of your nerve pain and providing effective treatments to relieve the pressure and resolve your symptoms.

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A Closer Look: Morton’s Neuroma

A Morton’s Neuroma is not a true tumor, but rather a thickening of the tissue surrounding the digital nerve that supplies sensation to the toes. It most frequently develops in the ball of the foot, between the third and fourth toes. This thickening is the body’s response to chronic irritation, compression, or stress on the nerve.

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Causes of Nerve Pain and Neuromas

The primary cause of nerve irritation leading to conditions like Morton’s Neuroma is excessive pressure on the forefoot. A podiatrist will identify several contributing factors:

• Improper Footwear: This is the most common culprit. Shoes that are too tight, narrow in the toe box, or have a high heel can squeeze the metatarsal bones together and compress the nerve running between them.
• Faulty Foot Mechanics: Biomechanical issues such as bunions, hammertoes, flat feet, or high arches can cause instability, leading to increased pressure and irritation on the nerves in the ball of the foot.
• Repetitive Stress: High-impact activities like running or court sports place repeated stress on the forefoot, which can aggravate the nerve.
• Trauma: A direct injury to the foot can also lead to inflammation and nerve damage.

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Symptoms of Nerve Pain in the Foot

Nerve pain, particularly from a Morton’s Neuroma, has a distinct set of symptoms. We recommend an evaluation if you experience:

• A persistent feeling that you are “walking on a marble” or that your sock is bunched up.
• Sharp, burning, or shooting pain in the ball of your foot that may radiate into your toes.
• Tingling or numbness in the affected toes.
• Pain that worsens when wearing tight shoes or during activities that put pressure on the forefoot.
• Symptoms that are often relieved by removing your shoes and massaging your foot.

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Diagnosing Nerve Pain: A Specialist’s Evaluation

An accurate diagnosis is essential to ensure you receive the right treatment. A podiatrist can typically diagnose a neuroma through a clinical evaluation:

• Physical Examination: We will carefully manipulate your foot and apply pressure to the area between the metatarsal heads. A palpable “click” or the replication of your pain (known as Mulder’s sign) is a strong indicator of a neuroma.
• Detailed History: Discussing your symptoms, activity level, and typical footwear provides critical clues for diagnosis.
• Imaging: While a neuroma won’t show up on an X-ray, we may order one to rule out other potential causes of your pain, such as a stress fracture. An ultrasound or MRI can be used to visualize the thickened nerve and confirm the diagnosis.

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Treatment for Nerve Pain: Relieving the Pressure

The goal of treatment is simple: reduce the pressure on the nerve to alleviate the pain. We always begin with conservative, non-invasive methods.

Conservative (Non-Surgical) Treatments:

• Footwear Modification: The first and most important step is switching to shoes with a wide toe box and a low heel to give your toes and nerves adequate space.
• Custom Orthotics: A podiatrist can design custom shoe inserts with a specialized metatarsal pad. This pad helps to lift and separate the metatarsal bones, reducing the compression on the nerve.
• Padding: Simple shoe pads can also help offload pressure from the painful area.
• Injections:
  • Cortisone Injections: A steroid injection can effectively reduce the swelling and inflammation of the nerve, often providing significant pain relief.
  • Alcohol Sclerosing Injections: A series of injections with a dilute alcohol solution can be used to shrink the nerve and reduce pain signals.

Surgical Intervention:

If your pain persists after exhausting conservative options, our podiatric surgeon may recommend a surgical procedure. This can involve either decompressing the nerve by releasing a tight ligament above it or, more commonly, removing the affected nerve (neurectomy).