A Frederick and Hagerstown foot and ankle surgeon warns female runners that the combination of wearing narrow, pointed-toed shoes at work and the pounding their feet endure from running on hard surfaces can cause a neuroma, a painful nerve disorder of the feet.

Active women who enjoy running, especially those with flat feet, are prone to develop neuromas.  A nerve located between the toes becomes enlarged and inflamed and produces tingling, burning pain.

Daniel D. Michaels, DPM, MS, FACFAS, is a member of the American College of Foot and Ankle Surgeons (ACFAS). He says the symptoms begin gradually and, left untreated, progressively worsen.

“We see neuromas quite often in younger professional women who wear high heels every day at work and also are active runners,” says Dr. Michaels. “It’s a very stressful combination for their feet.” 

Dr. Michaels explains that neuromas enlarge as the condition progresses, causing pain and numbness to a consistent area at the base of the toes. Patients often complain it feels as if something is stuck inside the ball of the foot. The symptoms may go away temporarily by massaging the foot, wearing wider shoes with low heels, and avoiding running and other activities that aggravate the condition.

“Symptoms become more intense as the nerve enlarges and the temporary damage becomes permanent, so it’s best to seek treatment if discomfort persists for more than a few days,” Dr. Michaels says.

Neuromas can develop in different areas of the foot. The most common occurrence is called Morton’s neuroma, which develops at the base of the third and fourth toes.  Thickening and swelling of the nerve usually is caused by compression and irritation from wearing very narrow shoes or high heels that crunch the toes in the front of the shoe. In addition, neuromas can result from running, racquet sports and other physical activities that exert repetitive stress on the forefoot.

A neuroma isn’t detectable by x-ray, so the diagnosis is based on symptoms and a physical examination to palpate the nerve or a maneuver that elicits an audible click.    

Treatment options for Morton’s neuroma depend on how far the condition has progressed. At early stages, padding lessens pressure on the nerve, icing reduces swelling, over-the-counter anti-inflammatory medications decrease pain and inflammation, and prescription or custom orthotic devices provide support to reduce compression. Patients also are advised to wear wider shoes with low heels and take a break from running or other activities until the condition improves.

If these conservative treatments don’t help then injecting the neuroma with alcohol and utilizing digital diagnostic ultrasound needle guidance can relieve the pain in the vast majority of patients.  It may take between 6-10 injections, sometimes as little as 1-2 to get complete relief.

In severe cases, surgery might be the best option to provide relief.

“Surgery for neuromas has a very high success rate,” said Dr. Michaels. 

For further information about foot or ankle conditions, contact one of our foot and ankle surgeons at the Reconstructive Foot & Ankle Institute, LLC.  Visit us on the web at www.rfainstitute.com or make an appointment with one of our state of the art offices in Maryland:

Hagerstown 301.797.8554, 1150 Professional Court, Suite C, 21740

Frederick 301.418.6014, 2100 Old Farm Drive, Suite D, 21702