When I am treating a neuroma for a patient I am trying to quiet down an inflamed nerve that is causing pain. The pain can be severe and often warrants fairly aggressive treatment. Other times the simplest form of treatment is all that is needed. Switching to a wider width shoe and avoiding thick socks can often eliminate symptoms from a neuroma. An open toe shoe or sandal works very well for many people with this problem. This is often done in conjunction with a short course of an anti-inflammatory medicine. If this works but not quite enough, the judicious use of a corticosteroid is often tried. I try to limit the numbers of injections given to 2 or 3. Steroid injections can be very effective in reducing the pain caused by a neuroma. Again, we are talking about a condition in some people that hurts so bad they avoid putting shoes on and have eliminated most of their activity due to the pain. Runners will stop running, dancers stop dancing and workers dread going to work. In these cases the possible benefits from an injection far outweigh possible side effects.
Recently, I have had good results with cryotherapy, the freezing of the affected nerve, which desensitizes the area thus reducing symptoms. Finally, their are those neuromas which do not respond to any of the above and hurt enough that excision is performed. The results of excision are favorable. I do the procedure at either Martha Jefferson Outpatient Surgery Center, Martha Jefferson Hospital or Augusta Health. It is a 20 – 30 minute procedure that is done with a local anesthesia and IV sedation provided by an anesthesiologist. Postoperatively rest and elevation is required for 2 weeks. This is followed by 2 weeks of decreased activity and an open toe shoe or sandal. Once successful treatment of the neuroma has taken place patients will get back to normal activity.
Plantar fasciitis remains one of the most common problems I treat. I see plantar fasciitis in factory workers, teachers, nurses and athletes in great numbers. These, and others, who are on their feet a lot are susceptible to this condition. It is very frustrating to have and can be frustrating to treat. It is technically an overuse injury. The cause is usually multifactorial with the combination of foot structure, activity level, shoes worn, body weight frequently coming into play. Several of the factors contributing to plantar fasciitis can be modified (activity, shoes worn) while others cannot (job requirements, foot structure).
For runners, tennis players, those who do aerobics or other impact weight bearing activity you usually have to take time off from your activity while being treated for this. This is a time to cross train. Swimming, bike riding, rowing machines, lifting weights on machines can usually be continued during treatment.
Shoes worn during treatment should be modified to include running shoes, good work boots or hiking shoes. Shoes worn should have rigid soles with adequate shock absorption. A key ingredient in shoes is a removable liner. We can then put in either a very supportive over the counter orthotic or a custom made functional orthotic into the shoe. This will provide extra support as well as shock absorption. Going barefoot should be avoided as well.
If the change in shoes and inserts do not help more aggressive treatment will be needed. An x-ray will sometimes be taken to rule out a stress fracture. A combination of taping, anti-inflammatories, orthotics, and corticosteroid injections might be needed to quiet the condition down. It can take 6 months to a year for bad cases to respond to treatment. Surgery is only considered when the above have failed to give relief. When surgery is performed I do a partial release of the plantar fascia. This can take several months to heal from. As stated, the procedure is reserved for those not getting better with more conservative care. For those who do need surgery you should know that the procedure works very well.
I had chronic plantar fasciitis in 1990 after the New York City Marathon and ended up being in the small group of patients not responding to care. In 1993 I had a partial release done and have not had problems since. Hopefully, you will not require this level of care but if you do we can help you.
Posted by Kevin Murray, DPM
Stress fractures can result from a number of reasons. Most common causes for stress fractures are decreased bone density, post-op complications from a foot surgery, and athletic training error / overuse injury in athletes, dancers, and “weekend warriors.” It typically occurs in the second metatarsal…. The longest of all central foot bones and the one subject to the most loading forces. Since the second metatarsal tends to carry more of the body’s weight during athletic and dance activities, the increase in pressure results in osteoclastic activity and compensatory osteoblastic activity becoming imbalanced.
A very common complaint presented by patients to their podiatrist is that of heel pain. It is caused by a variety of conditions but this blog will discuss heel pain due to plantar fasciitis. Plantar fasciitis is the most common condition associated with heel pain, especially in athletes, dancers and individuals within the ages of 40-60. It causes a mild discomfort to an aggressive form of pain in the plantar aspect of the foot- in the area of the heel.
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Keeping up with an exercise schedule during the winter can be difficult, as there are many obstacles faced by runners during the winter months. It is important to first and foremost dress appropriately for the weather wearing light layers of polypropylene or lycra under a wind/water repellent track suit. Hats that cover the ears are also extremely important as a lot of the body’s warmth is lost through the head, therefore it is crucial to conserve this heat. Gloves and thick absorbent socks are also imperative to prevent frostbite or poor circulation in the runner which can lead to a cascade of otherwise preventable problems. Proper winter running sneakers are essential to assist in the prevention of many slip and falls that occur on the ice or snow resulting in injured muscles or even broken bones. These shoes ought to be water proofed and one should also take into account the shoe size of their winter shoe, perhaps an increase in a half size to ensure the fit with the extra thick socks. For those who wear custom orthotics, one should consult his/her local podiatrist to customize an orthotic that would best fit their specific foot in the winter sneaker. Prevention of blisters and other shoe irritations should also be taken into consideration to ensure a comfortable workout experience. With the appropriate winter attire in place, the runner is almost prepared for his/her workout. But it is of high importance to properly warm up before facing the cold temperatures and even more important to warm down by stretching upon completion of the run. This protects the muscles from entering a sudden shock during the run and assists them in relaxing thereafter. One should be sure to keep his/her skin thoroughly moisturized and body well hydrated during these winter months while taking heed in the other precautions discussed, ensuring a safe and productive winter workout.