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Tag: neuroma

Having Pain in the Ball of Your Feet? Maybe it’s a Morton’s Neuroma

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morton's neuroma

One of the most common foot and ankle complaints I see in my patients is pain in the ball of their foot. The feeling of your sock wrinkled, or something in your shoe? Maybe an uncommon burning or tingling in your toes? You could have experienced an increased pain while in your tight shoes, high heels, or ski boots? These are the stories we hear from those suffering from Morton’s Neuroma.

What is a Neuroma?

The foot is built with a ligament that runs across the ball of the foot which we bear weight upon. This is called the transverse metatarsal ligament. Between the ligament and skin on the bottom of your foot is where the problem starts. It is thought that the ligament can rub on the nerve which irritates it. The nerve may even become swollen, which is what causes that “full” feeling so many people describe. Neuromas most frequently occur between the third and fourth toe called a Morton’s neuroma, or between the second and third toes. The word neuroma may imply a tumor, but it is not. No need to fear, the nerve is simply swollen from the pressure of the ligament.

What Causes a Neuroma?

Neuromas may just happen! There is no correlation with certain foot types. There may be little evidence to suggest that flatfeet or high arch feet are problematic. However, one exception is called Morton’s Foot. This is a foot that has a short first metatarsal bone that is the bone for the great toe joint. When it is too short, it places more weight on the second or third interspaces.

Additional Causes

  • High Heel Shoes: These put more weight on the ball of the foot.
  • Tight Fitting Shoes: This may squeeze the metatarsal bones on the foot on the nerve and injure it.
  • Trauma: When something is dropped on the foot, or the toes are extended upward in the case of stubbing your toe.
  • Bunions: Having a bunion deformity will make your foot wider, and this can make shoes tighter causing a neuroma.

How Do You Know If Your Foot Pain is From Morton’s Neuroma?

  • X-rays: Taking x-rays can rule out other bone or joint problems that can mimic a neuroma. But a neuroma cannot be seen on x-ray, as it is a soft tissue problem.
  • Ultrasound: Using ultrasound imaging can often show that the nerve is swollen
  • MRI: This form of imaging may also be useful.

Out of all, the most important step to knowing is a doctor’s clinical examination and your specific symptoms.

When it comes to treatment, you may find relief by doing the following: Avoid wearing shoes that are too tight, and wear shoes that have plenty of width. Avoid high heels, as this puts more weight on the ball of the foot. Use ice packs, especially in the early stages. Try over the counter shoe inserts.

If these options fail for Morton’s Neuroma, the options that your podiatrist would consider could be:

  • Cortisone Injections: A series of two or three of these may resolve the pain permanently
  • Custom Shoe Inserts: This can be highly successful as they get to the root cause of the problem. This treats the source by supporting the bony structures and ligaments so irritation to the nerve is reduced. The orthotics are made from a non-weight bearing neutral position of your foot to optimize support and control.
  • Laser Treatment: Lasers may also be very successful. It works on the concept of helping the mitochondria in your nerve cells. In every cell of your body, there is an area called the mitochondria that creates energy for the cell. Laser helps the cells to repair.
  • Regenerative Medicine: We have had success with regenerative medicine (stem cell). This shows some promise for neuroma pain that is not severe after other conservative treatments failed.

Two Surgical Options for Morton’s Neuroma

  • Nerve Decompression Surgery: The surgeon will make an incision on the top of the foot and release (decompress) the ligament above the nerve, so it no longer irritates the nerve.
  • Nerve Resection: When this surgery is performed, not only does the surgery cut the ligament to get access to the nerve, but also then removes a section of the nerve

Pros and Cons of These Two Options

This surgeon prefers the nerve decompression technique because of its high success rate, and you’re keeping your nerve. The foot tends to feel more normal after this surgery than if the nerve branch is removed. When nerve resection is performed, the foot may not feel as normal but also the nerve stump that is left behind can cause another issue called “amputation neuroma” or “nerve stump”. This can cause another issue for the patient. Along with this, the Associations of Extremity Nerve surgeons who arguably are the best trained doctors for lower extremity nerve evaluation and treatment, support nerve decompression and advise against neuroma resection.

Nerve Ablation and Alcohol Injections: These options are less common amongst podiatrists. The drawback to both options is that they are destructive to the nerve. Alcohol injections gradually kill the nerve over a series of injections. Nerve ablation uses heat to kill the nerve. If alcohol injections or nerve ablation fail, then it makes the option of nerve decompression less optimal as the nerve has been damaged, and nerve section will more likely be suggested by the surgeon. That’s why this surgeon does not suggest these treatments as my philosophy is to keep the nerve.

When either of these surgeries is performed, the patient may walk immediately, and most patients are back to regular shoes in 3 weeks. The good news is that many patients we see can avoid surgery. Early treatment is important. If you take the steps we’ve discussed and the pain persists, make sure to contact your podiatrist.

Dr. James Anderson

Diana shares her experience of getting 100 percent pain relief!

3 Reasons Custom Orthotics Work

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Summer is finally here, and we all want to be outside enjoying the warm weather and sunshine! Unfortunately, increasing our activity level can cause unwelcome and nagging pain that limits our ability to walk, hike, or take on a running race. There is a solution however, so read on!

Today, let’s discuss custom orthotics and how they can likely benefit you. Custom orthotics can be very effective in treating many common issues including plantar fasciitis, tendonitis, and chronic joint pain.

If you are experiencing chronic, unresolved foot pain, custom orthotics might be right for you. Here’s why.

1. They are made for your foot, not anyone else’s 

The over the counter shoe inserts (Dr. Scholl’s for example) only provide some additional cushioning and can’t compare to a prescription custom orthotic in arch and foot support. By the time a patient makes an appointment to see a foot doctor, they have often tried one or more different store-bought orthotics without much success or relief.

The process we like to use to make custom orthotics involves making a plaster mold of your feet in a biomechanically corrected/ideal position. This allows us to get an exact replica of your foot, which can be used to create an insert that is not only comfortable, but also highly supportive of any painful joints and tendons, and again, made specifically for you.

2. Technology has improved

Gone are the days of clunky, heavy inserts. Those were not pretty, they only fit in a few shoes and must have weighed five pounds each! But, they worked great and helped relieve pain.

The good news is, over the past 20 years or so, the technology and materials used for orthotics has greatly improved, so today’s orthotics are much lighter and thinner and can be used in a variety of athletic and dress shoes. This way, whether you are running a marathon, walking around the office, or attending a social event, your feet can have the support and comfort they need without having to be in tennis shoes all the time.

3. More comfort, less pain 

Because that’s the whole point, right?

Most chronic foot pain is the result of daily wear and tear on the structures in your foot. Better, biomechanically corrected support results in less day-to-day damage and inflammation, and most importantly, less pain.

So whatever your particular foot aches and pains are, there is likely a custom orthotic option for you. I would encourage you to make an appointment to discuss what those options are. Even if you have had other inserts in the past that have not helped, I would recommend not giving up on orthotics just yet.

Come on in and discuss your options. Your feet will thank you for it.

CJ’s Story: Chronic Tendon Pain (The Power of Regenerative Medicine)

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CJs testimonials chronic tendon pain

The new year is here, and for many of us that means it’s time to focus on our health, and address some of those lingering issues we’ve been putting off.

Today, I will share a success story of a patient who was dealing with chronic joint and tendon pain for several years. My goal is to help instill hope in many of you who have been experiencing similar pain, and have perhaps given up on finding a solution. So, here we go.

52, Healthy and Active

This patient is a 52 year-old female, who was healthy and active. We will call her CJ. She came into my office with a variety of foot complaints. The primary issue was chronic joint and tendon pain in her right foot and ankle, and this had been going on for several years.

Seven years prior, a horse stepped on her foot and she was diagnosed with a “hairline fracture” and wore a cast for three months. Once she was out of the cast, she could get back to activity with little pain. However, over the next five to six years, she started having more and more pain in the area that began to significantly limit her activity. This gradually led to weight gain, which only made the problem worse.

Plantar Fasciitis, Arthritis and Tendon Pain

When I first saw CJ, she was planning on having gastric bypass surgery, but was concerned that she would not be able to exercise properly after the surgery because of her foot and ankle pain. She had previously been treated for plantar fasciitis by another doctor.  She had steroid injections and wore a night splint, but neither treatment seemed to give her any relief.

During her initial exam, her X-rays showed that the old injury had been more than just a hairline fracture. She had evidence of post-fracture arthritis in two joints in the middle of her foot. The fracture had healed, but left joint damage behind. Her other main issue of ankle pain was diagnosed as a partial tendon tear. This had likely been aggravated by compensating for the joint pain.

Regenerative Medicine + Surgery

Many times, when patients present with arthritis, tendon pain, or plantar fasciitis, we use regenerative medicine therapy to help stimulate healing and avoid surgery altogether. But, in CJ’s case, we needed to use several different treatments to help address all the issues that had been accumulating for all these years.

We performed surgery to repair the tendon tear and used regenerative injections to help heal the joint damage. To better support the damaged joints, we fitted her for custom orthotics. She then began physical therapy to improve her strength, balance, and flexibility.

Ten Weeks Later

CJ was on crutches for four weeks after the tendon repair. But, once we cleared her to start walking, she progressed quickly. She was highly motivated and committed to her therapy and post-operative rehab. Ten weeks after surgery and regenerative therapy, she was already back to walking and elliptical workouts daily. She still has the occasional sore muscles, but no longer has anywhere near the pain she did before. CJ is still considering gastric bypass surgery. But, she now feels she will be able to lose the weight without it since she can exercise without pain.

So, if you or someone you love is struggling with daily foot or ankle pain, please don’t wait any longer to address it. Call today to make an appointment, and we can discuss treatment options with you.

2018 can be your last year to deal with chronic pain. It’s time to get on the path to healing, together.

Chronic Foot Pain: Why Am I Still in Pain?

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It’s never fun to suffer an injury of any kind. There is always the initial pain and limitations. But, what happens when the pain doesn’t go away even when the injury is “healed?”

Does it just need more time? Are you doing something wrong? In many cases, the injuries look completely healed on X-rays or MRI, but the pain continues. So what do you do next?

I’d like to tell you a story about a patient who had just this problem. We will call her Alice.

The Ankle Fracture that “Healed”

Alice is a 32 year-old female patient. She came to see me for severe daily pain in her foot and ankle, which initially started after she fractured her ankle. Alice fell on her ankle and heard/felt a pop. She was evaluated in the ER and properly diagnosed, and subsequently had surgery to repair the fracture. The repair went as planned and after six weeks her X-rays showed a completely healed fracture.

She was then allowed to start walking on it again. That was when her pain really started. After surgery, she had experienced the normal post-op pain, but it wasn’t until she was out of a cast that she began having constant ankle and foot pain that was not relieved by much of anything. It hurt when she walked and it hurt when she didn’t walk. The pain woke her up and kept her awake.

Time to Put on My Detective Hat

Alice was at the end of her rope, and was even considering possible amputation if the pain could not be relieved. With any patient in this much pain, my first impulse was to throw the kitchen sink at her problem to try to find some way of getting her relief. However, in order to help these patients, I know I have to put on my detective hat, do a thorough review of their injury, treatment, and health history, and then put together a step-by-step plan to hone in on the primary cause of the pain.

A Painful Scar

Alice had pain throughout her foot and ankle, but the majority of the constant pain was along the inside of the ankle and down into the foot. This area was so sensitive that any light touch would send pain up and down her leg. She was especially sensitive along a surgical scar from her ankle fracture repair.

She had mentioned this to the surgeon who fixed her ankle and he assumed it was simply a painful scar and would improve with time but instead the pain grew steadily worse. An X-ray showed the screws and plates in the bones did not appear to be causing any problem and the scar itself did not appear thickened or contracted. However, the location of the incision was right over one of the main nerves in the leg, and I considered the possibility that the nerve had been damaged or cut during the fracture repair.

Testing the Theory

A simple way to test this theory was to perform a diagnostic nerve block of the nerve higher up the leg with a long-acting local anesthetic and a small amount of steroid. This will decrease inflammation and reduce sensitivity of the nerve for 2-3 days after the injection.

If the patient’s symptoms significantly improve for a few days after the injection, then it is a good bet that the nerve itself is the source of the pain and not just the messenger. If it only feels better while it is numb, then it’s time to head back to the drawing board. Alice had significant improvement for 3-4 days after the block before the pain returned. This is normal and expected because you can only use this injection for diagnosis, not treatment.

The Source of the Pain

Once we knew the nerve was the source of her pain, it was time for treatment. In this case, I recommended a procedure called a neurectomy of the nerve. This involves making a small incision over the nerve, farther up the leg than the damaged portion. I then locate the nerve, and cut it to shut off the pain signals. It’s kind of like throwing a breaker on an electrical outlet.

Although this might sound drastic, it is a much safer and effective option than other chronic pain management options (opiates or a spinal stimulator for example). For Alice, it worked very well. Once the nerve pain was eliminated, she was finally able to participate in physical therapy to address the other tendon pain and weakness that had developed from how she was compensating for the pain.

Finally, Pain Free

At Alice’s last follow up, she was pain free. She still had a bit of residual limp that will continue to improve with therapy. I present Alice’s story as an example of the complex diagnostic work-up often involved with post-traumatic chronic pain.

No two patients are the same and no two injuries are the same. What worked on one may not work on the other. As a doctor, when I see patients with chronic pain, I have two goals in mind.

1. Identify the primary problem.

2. Do not aggravate the pain any further with unnecessary treatments.

Once we identify the root of the issue, we can then proceed with the appropriate treatment to relieve the patient’s pain.

If you are experiencing chronic injuries or unresolved pain, please come see us! We can help. Come visit your podiatrist in Fort Collins or Broomfield for further consultation.

To learn more about our treatment options, click here.

Book your appointment here. 

Debra’s Story: Relief from Chronic Pain

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Every patient we see is unique, but unfortunately, many of them come in telling a similar story. They are suffering from chronic pain and are searching for answers. They want to avoid the medications, the spinal injections, and the spinal stimulators that are commonly used for the treatment of chronic pain problems.

At Anderson Center for Nerve Pain, we focus on treating patients with chronic pain or numbness throughout the body due to diabetic neuropathy, chemotherapy treatments, trauma or surgery. If your pain or numbness is due to injury or entrapment or compression of one or more peripheral nerves, there is a very high chance that we can help. We utilize one or more of several successful treatment methods, depending on each patient’s needs:

Here’s Debra’s story. Our hope is that if you are suffering today, this will encourage you to not give up.

Everything Looked Good

Debra came to our Fort Collins office from Denver. She had a complex injury to her foot due to a fractured heel. With this type of injury, it is not uncommon for surgery to be indicated to put the heel back in the proper position. This injury will typically present with not one, but multiple fractures. Her X-rays showed screws and plates in the heel bone, and everything looked good.

But She Was Not So Good

Debra was suffering from chronic pain. She had severe burning, tingling, numbness, and throbbing in her foot and into her leg.  She had been referred to a pain clinic and was on narcotics, which were causing her to fall asleep at work. Because the fatigue was so extreme, she was going to bed at 7:00pm, and she felt it was dangerous for her to even drive her children around. The next step for her was to consider a spinal implant for electrical stimulation to help with her pain. Drugs and the implant are common conventional methods to help these patients. She came to me to explore her other options.

New Hope

After examining Debra, it was apparent that a nerve had been damaged from the surgery she had. The surgery was a success in terms of repairing the broken heel, but she was now left with residual pain. A small nerve called the sural nerve that lies on the outside of the ankle became entangled in the scar tissue from the surgery. On her first visit I injected a small amount of local anesthetic with cortisone above the area of nerve damage. She returned several days later and said, “The pain is coming back, but for three days, it was almost completely gone!”

Because of her chronic pain, the doctor had warned her not to contemplate any kind of surgery in the foot or leg, so we did another injection. She came back again and again, and with the same response each time! Eventually after two or three injections to calm this injured nerve, she had faith in what I was suggesting that we do.

The Source of the Pain

So what did we do? Because of the severe amount of damage to the nerve, we made a small incision in her lower leg just above the ankle. Through this incision, we cut the nerve and buried the tip in the muscle. Why the removal? The nerve was the pain generator. Why did we bury the tip in the muscle? This is commonly done to minimize the possibility of the tip of the nerve causing pain. When a nerve is cut, it wants to recreate more nerve tissue and we call this an amputation, or stump neuroma. By burying the nerve in the muscle, it reduces the chance of the area being sensitive to touch.

It is very important to note two things:

  1. The nerve removed does not supply any muscles that could result in weakness. In fact, she should become stronger as she can now use her pain-free leg even more!
  2. The numbness tends to go away as the other remaining nerves will sprout new branches and make up for her numbness. Months later, most patients report minimal numbness.

What We Believe

My message to you is this. If you or someone you love is suffering from chronic pain, please do not give up hope. Maybe you are on medications and struggling with the side effects. Maybe you are suffering from the stress or depression caused by chronic pain.

We believe that the time has come to change the game regarding the approach to helping people suffering from chronic pain. We may be able to address the source of your pain just like we did for Debra.

Don’t wait. Come see us. Click here to make an appointment.

Why Treadmill Running on an Incline is a Bad Idea

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I treat a wide variety of sports-related aches, pains, and injuries involving the feet and ankles. While there is no sure fire way to avoid all of these issues, there are some common workout methods that can aggravate your feet more than others. Over the years, I have learned to ask for detailed info on a patient’s exercise regimen. For example, the type of running shoes, hiking boots, etc they use is important. The type of surface they are running/walking on, warm up and cool down techniques, etc. are all very important.

This advice does not pertain to everyone or every situation. If you do any of these things and don’t have pain, then feel free to keep doing what you are doing. But, if you have been dealing with nagging foot pain that isn’t going away, then read on. A simple change in how you exercise may help.

1. Treadmill Running + Incline = Pain

This is one I have seen quite frequently. Just running on a treadmill is fine in most cases. But, once you start cranking up that incline, the chances of pain and injury also start to climb.  As the pitch increases, you start running more on just the ball of your foot. This does three things.

  1. Focuses all the impact on just the ball of the foot.
  2. Prevents normal rear-foot pronation which leads to decreased shock absorption to the whole foot.
  3. Causes increased tension/strain on the Achilles tendon and maintains this strain throughout the stride.

These things can lead to development or worsening of neuroma pain, plantar fascia pain, Achilles tendonitis, and joint pain in the ball of the foot. So if you routinely use the treadmill on an incline, and have been having any type of foot pain, keep the treadmill flat or run outside or on a track if possible.  This may not solve the problem right away, but can be a good starting point.

2. Barefoot + Running = no problem (most of the time)

BUT:  Barefoot + Dance/Aerobics/Zumba/etc = Ouch

For many years now barefoot running has been touted as good for your feet and for many people this can be true.  However, just because barefoot running may have some benefits, it doesn’t mean that being barefoot during other types of workouts is just the same. For example, dance-type aerobic workouts like Zumba are very popular, and can be a great workout, as well as a lot of fun. But these types of activities (usually done on hard surfaces) involve quite a bit of repetitive stress and impact on the feet and should rarely, if ever, be done barefoot. A decent pair of athletic shoes will provide the necessary shock absorption and support to keep your feet happy and healthy.

3. Beware of the “Minimalist” Shoes

Over the past few years, “minimalist” shoes have been popular and are marketed as having similar benefits as barefoot-type shoes. These minimalist shoes are typically very lightweight, flexible and offer little benefit for either support or shock absorption. In addition, since the foot’s motion is still confined in a shoe, they do not have the foot strengthening benefits of barefoot shoes.  In short, they provide all of the negatives of barefoot running and none of the positives. Stiffer soled shoes with adequate cushion are usually the better option if you are having any chronic foot pain.

As I mentioned before, these recommendations do not pertain to every person in every instance. However, if you regularly do any sort of these workouts and have any foot pain associated with it, then it may be a good idea to make some minor adjustments to your routine. Your feet will thank you for years to come.

If you are experiencing unresolved  foot pain, come see us! We can help.

Book your appointment here.