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Quick Action To Fix Foot
Pain Reduces Need For Surgery

By Dr. David Zuckerman

If your fitness plan includes a brisk walk daily, you may experience a dull soreness on the bottom of your feet.

It could become intense burning, cramping, numbness or stabbing pain, especially in the ball of your foot and between the toes. Removing your shoes and massaging the foot helps, but walking especially in dress shoes, is torture.

The source of your pain is probably intermetatarsal neuroma (IMN), inflammation and enlargement of the nerve that runs between the metatarsal bones and provides sensation to the lower foot and toes.

Foot bones or ligaments can entrap or squeeze the nerve, causing it to swell. The injury can occur between any toes, but it usually strikes at a juncture between the third and fourth toes, where more than one nerve join. Unless the condition is treated promptly, permanent damage can result.

Not surprisingly, 88 percent to 95 percent of IMNs are found in women, who may squeeze their feet into narrow, pointed shoes. High heels, which flex the foot and strain the nerve, can also aggravate IMN.

A walking gait imbalance or repeated trauma to the foot during sports such as basketball, tennis and aerobics can also cause IMN, as well as bursitis, arthritis, or a cyst on the nerve.

Prevention is the best medicine for IMN. Save high heels for rare occasions and avoid tight shoes or hose. Choose athletic shoes carefully, making sure they don't squeeze the sides of the foot or tops of the toes.

Once the intermetatarsal nerve becomes enlarged and causes pain, early treatment is imperative. Modifying activity and shoe gear helps. Cold therapy and analgesics are useful, as well as physical therapy. Corticosteroid injections often bring relief.

Gait imbalance resulting from structural or mechanical handicaps can often be corrected by taping or padding the foot, or fitting the shoe with an orthotic. These procedures stabilize the biomechanics and weight-bearing force on the foot and reduce nerve irritation.

But quick action is crucial. Failing to correct IMN or masking its pain with drugs can result in permanent nerve damage that responds only to surgery.

Surgery is a last resort, when the pain is chronic and IMN doesn't respond to conservative treatment. This minor procedure requires a local anesthetic and usually takes place in the podiatrist's office or on an outpatient basis. A very small incision - about 1 inche - is made in the top of the foot near the web between the toes. The nerve is freed and the damaged portion is removed. Because the incision is on the upper foot, the patient can walk and drive immediately.

The stitches are removed in about two weeks. The patient can then return to work, unless the job requires heavy lifting or standing all day.

Remember, pain is your signal to seek treatment. During your lifetime, your feet will have to carry you the equivalent of four times around the earth. Don't neglect them.

This is a reprint from the Pulse Section of the Courier Post.

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David Zuckerman DPM
The Foot Specialist, P.C.
341 S. Evergreen Ave.
Woodbury, NJ 08096

Telephone: (856) 848-3338
Fax: (856) 848-5122