When severe foot pain just won’t go away, you may think that surgery is the only solution. Fortunately, that’s not always true. There are several nonsurgical options available.
Here’s the catch: Your podiatrist might not suggest these nonsurgical approaches—most doctors who treat foot disorders are used to patients demanding the “quick fix” of surgery (even though there’s no guarantee of fast or lasting relief).
But in my experience, nonsurgical therapies such as those described here improve the pain by 60% to 80% in most cases—and completely eliminate it in some people—within six to eight weeks.
If your feet are affected by severe degenerative joint disease, surgery may be required.* But most people are able to avoid the risks associated with foot surgery (such as pain and infection) with one of the innovative and effective options for the conditions listed below…
A neuroma is a benign tumor on a nerve. Morton’s neuroma is a thickened area of nerve tissue that causes pain in the ball of the foot. Tight, pointy and/or high-heeled shoes can squeeze the toes together, causing the nerve leading to the toes to swell and thicken. Sometimes age alone causes this condition. People with flat feet or high arches are at increased risk—the nerve is more likely to get irritated.
Roomier footwear, orthotics (custom shoe inserts and pads), ice packs, anti-inflammatory drugs and cortisone injections are the standard recommendations. In people who opt for surgery, a small piece of the affected nerve is removed to release the pressure.
Surprising fix: Radiofrequency treatment, which is often used to treat back pain, can help. In a 2012 analysis of 29 patients who received this treatment for Morton’s neuroma, 83% experienced complete relief of pain.
What happens: The foot is first numbed, then a thin needle attached to a small radiofrequency device is inserted into the neuroma, delivering a computer-generated signal that stuns and shrinks the nerve. The procedure is generally performed in a hospital operating room because the radiofrequency equipment is usually not available in podiatrists’ offices.
Radiofrequency treatment of neuromas is still considered experimental, so check with your insurer to confirm coverage.
With this condition, one of your toes becomes permanently bent at the middle joint due to pressure on the toes’ muscles and ligaments.
Hammertoes are mainly caused by shoes with a low toe box in which the toe joint presses into the top of the shoe. Arthritis, toe injuries and a family history of hammertoes also increase risk. Traditional treatments include padding the hammertoe with a silicone or gel pad.
Stretching exercises also may be useful. What to do: Take hold of the tip of the toe and gently pull it out straight. Hold for five seconds. Repeat the exercise three times a day.
If these measures are not effective, a surgeon can make a small incision to straighten the tendon associated with the hammertoe and/or remove some of the affected bone.
Surprising fix: It sounds obvious, but the best solution is to look for a shoe with a roomy toe box and a heel of an inch to an inch-and-a-half—the range that supports your foot’s natural curve. Contrary to what many people think, flats and very low heels do not give the most natural foot position.
If wearing different shoes doesn’t give you adequate relief, an injection of a hyaluronic acid gel filler commonly used to help smooth wrinkles, such as Juvéderm Ultra 4 or Restylane, works well for reducing the pain of a hammertoe.
What happens: This 10-minute office procedure begins with an injection of lidocaine to numb the affected area. An injection of hyaluronic acid is then administered at the bony top of the bent toe. Hyaluronic acid for hammertoes is not covered by insurance—treatment for one hammertoe usually requires one syringe, which costs $700 to $1,000. The effect generally lasts for six to nine months.
A bunion is a bony bump that develops over the joint at the base of your big toe. Too-tight shoes are commonly the culprit, but bunions may also be inherited or can occur if you have arthritis.
Besides causing pain, bunions can create tingling from nerve compression. Orthotics and ice can help alleviate pain, and steroid injections can ease joint inflammation. But these treatments won’t get rid of the bunion. If you do opt for surgery, a bunionectomy (a small incision is made so that the bunion can be removed and the big toe straightened) can be effective. Most individuals are back on their feet within three days, but full recovery can take up to eight weeks. Swelling may last for six months.
Surprising fix: Before resorting to surgery, start by loosening your shoelaces and/or buying slightly larger shoes. Your bunion may be taking up space in your shoes and compressing the nerves.
To ease pain in the big-toe joint, bunion sufferers should wear rigid shoes that provide extra support to the painful joint. (When shopping for a shoe, try to twist the sole…if you can twist it, put it back.) Good brands for men: Rockport Dressports, Ecco and Allen Edmonds. Good brands for women: Munro, Ariat and BeautiFeel. Avoid flip-flops—they provide no support, which worsens bunions.
In addition, consider wearing a night splint (available at drugstores and online), which can help stretch and straighten the joint. Good product: The PediFix Nighttime Bunion Regulator, about $24.
Exercise will not change the bony overgrowth on the bunion but may help ease the pain. What to do: While slightly lifting your foot off the ground, point it straight ahead and hold for five seconds. Then curl your toes under for five seconds. Repeat 10 times daily.
Plantar warts are noncancerous skin growths on the soles of the feet. The warts are caused by an infection with the human papillomavirus. You can catch the virus if you have a cut or scrape on your foot and walk barefoot in a public shower or gym locker room.
Some people try various over-the-counter products, such as salicylic acid. Others cover the wart with duct tape (with or without Aldara, a genital wart cream), and sometimes it falls off. However, these therapies aren’t always successful, so some sufferers opt for surgical removal. Unfortunately, this can cause scarring that may lead to lifelong pain and discomfort.
Surprising fix: An injection of the chemotherapy drug bleomycin sulfate. Multiple studies have shown cure rates of 87% to 96% for plantar warts. Bleomycin sulfate is believed to kill the wart virus by stimulating the immune system to fight off the virus. The FDA has not approved the drug for plantar warts, but it can be used off-label for this purpose. When used in the small dose needed to treat plantar warts, common side effects of chemotherapy (such as hair loss and fatigue) do not occur.
Many insurance companies will cover this technique if it is preauthorized. Ask your podiatrist to inquire on your behalf. Be sure your podiatrist is experienced—permanent pain at the injection site can result if the drug is administered improperly.
*If you have diabetes or smoke, you may not be a candidate for foot surgery due to poor circulation. Speak to your primary health-care provider for advice.
