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December 2010: Holiday Shoes and Foot Neuromas

30 Nov 2010

Dr. Tammi Chapman is a podiatrist at Weiss Memorial Hospital. Her areas of expertise are sports medicine, preventive medicine and foot surgery. She is a member of the Weiss sports medicine team that provides medical services to the Chicago Red Stars women’s professional soccer team and the Chicago Sky women’s professional basketball team.

Tammi Chapman, D.P.M.
Weiss Memorial Hospital
(312) 236-3507

With the holidays rapidly approaching, we all want to look our best. While dress shoes may go nicely with your outfit, they may not fit your feet properly and may cause discomfort. A very common ailment from wearing ill-fitting shoes is a neuroma.

A neuroma is a painful growth of nerve tissue in the foot. It most often occurs between the third and fourth toe bones. Tight shoes or high heels cause the toe bones to irritate the nerve. With the constant irritation, the nerve begins to form scar tissue and thus forms a neuroma. As the neuroma worsens, it can cause foot pain and keep you from the activities you enjoy, like dancing in those favorite high heels. Fortunately, there are many treatments that can provide relief.

Symptoms of neuroma often start slowly. When the nerve becomes irritated over a period of time, you may feel a sharp, burning pain in the ball of the foot, especially when walking. Sometimes the burning sensation may subside by rubbing the foot. You may also notice a tingling or numbness between the toes. The toes at times can cramp or ache and relax when the foot is massaged. Some people relate the feeling of a lump or rock in their shoe.

Diagnostic tests
Certain tests can help evaluate and accurately diagnose a neuroma. X-rays, for example, do not show soft tissue, but they can be used to look at the structure of the foot and rule out other causes that can mimic similar pain, such as a stress fracture. Ultrasound can be used to see the nerve and the scar tissue surrounding it. A diagnostic nerve block also can be helpful. With a nerve block, a local anesthetic is injected into the area of the neuroma. If the patient feels relief from the symptoms, the doctor will know that the nerve is being affected.

Shoes with good support, a wide toe box and thick soles can help to prevent nerve irritation. Try to avoid wearing high heels as much as possible. If needed, custom shoe inserts (orthotics) can help provide pain relief, improve the function of the foot and provide extra support to the foot. Padding around the nerve can be placed directly on the foot or on the insole of the shoe to decrease pressure on the nerve. Beyond these measures, several other treatment options are available to help relieve neuroma pain, including:

  • Massaging and using an ice pack to reduce pain and swelling
  • Physical therapy, ultrasound and whirlpools
  • Over-the-counter anti-inflammatory medications can help, but sometimes a prescription strength medication may be needed.
  • An injection of cortisone directly into the area of the inflamed nerve

If these simple treatments have not helped, a more aggressive treatment may be the next step. Surgery, performed in a surgical center or hospital, can remove the neuroma. During surgery, the area of the enlarged scarred nerve is removed with a small incision in the foot. The area of the removed neuroma will have a permanent decrease in sensation, due to the small piece of damaged nerve being removed. Another treatment is sclerotherapy. This is done by a series of alcohol injections into the area of the neuroma, which causes the nerve to become numb. Several injections are usually needed and can be performed in the doctor’s office.

For more information
If you would like more information about keeping your feet healthy and pain-free this holiday season and all year long, or would like an appointment, please call Dr. Chapman’s office at (312) 236-3507.