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Painful Neuromas

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Bottom Line/HEALTH: Imagine if every time you stood up, you got a sharp, shooting pain going through your foot. That’s what millions of people experience every single day when they have a neuroma. Well, how do you avoid it, and how do you stop it? That’s the question today in Bottom Line’s Conversation With the Experts. I’m Sarah Hiner, president of Bottom Line Publications, and today I’m talking to Dr. Johanna Youner, a leading podiatrist and foot surgeon in private practice in New York. Welcome, Dr. Youner.
Dr. Johanna Youner: Thank you, Sarah. It’s great to be here.
Bottom Line: Let’s define what a neuroma is and why these people are suffering from shooting pain.
Dr. Youner: A neuroma is a thickening of nerve tissue in the foot. And you can see on this slide, between the fourth and the third toe is a classic Morton’s neuroma. It is a nerve that is always there, but because of shoes squashing the forefoot, the nerve thickens and creates a very painful situation, sometimes scarring.
Bottom Line: This is something that I’ll call it is manmade. We’re doing it to ourselves with shoes.
Dr. Youner: Absolutely.
Bottom Line: And is a neuroma dangerous?
Dr. Youner: A neuroma is not dangerous, but it can really impact your life and your walking. So by that, it can affect your life. It needs to be treated.
Bottom Line: Left untreated, will it get worse?
Dr. Youner: Left untreated, it’ll get worse until you need treatment. And treatment may go from different injection therapies to actually removing the neuroma.
Bottom Line: Once you get one, are you prone to it?
Dr. Youner: No.
Bottom Line: So it’s just once. What happens after, if you surgically remove it—now you don’t have nerves there?
Dr. Youner: You can get numbness at the area where they took out the neuroma. Some people can get what’s called an amputation neuroma, meaning a neuroma can start where the nerve was cut. These are not average things…these are complications.
Bottom Line: We just kind of ran ahead talking about surgery, so let’s talk about what the treatment options are for neuromas.
Dr. Youner: The very first treatment is to pad the foot or the shoe, to separate the bones that are pressing on the nerve tissue.
Bottom Line: So I’m putting a pad in my shoe? Should I just change my shoes and keep those pretty high heels off for a bit?
Dr. Youner: Pretty high heels off. Put a pad under where the bones are that are affecting. Your doctor can direct you to exactly where the problem is. You may feel pain in your toes, but the problem is actually inside your foot.
Bottom Line: So pad my shoes…second option is…
Dr. Youner: Wider shoes.
Bottom Line: Wider shoes.
Dr. Youner: Absolutely. That’s the number-one treatment—wider shoes.
Bottom Line: Do men and women get neuromas?
Dr. Youner: Yes, men do. Especially men who are in industries where they have to wear dress shoes get neuromas.
Bottom Line: So it’s not just women’s pretty shoes.
Dr. Youner: It’s men’s pretty shoes as well. And they’re much more unforgiving.
Bottom Line: Let’s go back to the treatments, because I’m bouncing around. What about radio frequency treatment?
Dr. Youner: There are different treatments now for nerves, and one of the treatments is with a radio frequency. It is a computer-generated signal through a needle. It can be done very simply on an outpatient scale. It is a needle into the neuroma, and it stuns the neuroma and can eradicate the pain without any invasive treatment. It’s amazing.
Bottom Line: Assuming that shoes doesn’t work…assuming that changing the shoes and the padding doesn’t work…next up, if I really do need some treatment, is that your top pick?
Dr. Youner: No, that’s more invasive. My first treatment is injection. Depending on how the neuroma is—is it an inflamed neuroma? If it’s inflamed, I will give a steroid injection. If it’s just a thickened neuroma, I can use what’s called a sclerosing injection. The sclerosing injection literally shrinks the neuroma with sclerosing solution.
Bottom Line: And then you mentioned surgery.
Dr. Youner: The more interventional techniques—radio frequency, the computer-generated signal on a needle into the neuroma—can be very effective. And there’s also removing the neuroma—doing foot surgery, opening up the foot, removing the neuroma.
Bottom Line: What are the odds, because I don’t like surgery and I don’t like needles, if I get a neuroma, and I’m very diligent about changing my shoes and padding my shoes, that I can cure it on my own?
Dr. Youner: It is not a curable problem. The neuroma will stay there. As long as you stop the pain, it can stay there for the rest of your life without a problem. If you have pain, it needs to be addressed.
Bottom Line: So you could have a neuroma and it’s not necessarily painful?
Dr. Youner: Absolutely.
Bottom Line: So it passes a threshold of pain?
Dr. Youner: If you have an inflamed neuroma, it may calm down simply by taking Aleve or Advil and calming the inflammation down. If the neuroma has grown so large that you are unable to put on a pair of closed shoes, it needs to be addressed.
Bottom Line: Once again, as usual, pain is actually in some ways the guide on this. It could be perfectly fine…I may or may not even know I have it. As long as I’m not in pain, it doesn’t really matter.
Dr. Youner: Exactly.
Bottom Line: And prevention?
Dr. Youner: Wider shoes. No pointy shoes. And make sure as we age and our feet change and grow, we go up a half size.
Bottom Line: All right. Thank you, Dr. Youner. The bottom line on neuromas? Once again, we are inflicting our own pain on ourselves. So if you wear shoes that give your toes enough room and shoes that have enough padding, you shouldn’t have any problem. If you start to get some foot pain, again, change your shoes, and if the pain doesn’t go away, to the podiatrist you go. This is Sarah Hiner with Bottom Line.
 
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Source: Johanna S. Youner, DPM, a podiatric surgeon in private practice and attending physician at New York Downtown Hospital, both in New York City. Dr. Youner is a board-certified foot surgeon and a Fellow of the American College of Foot and Ankle Surgeons. HealthyFeetNY.net Date: September 29, 2014 Publication: Bottom Line Health
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