“Hi, this is Dr. Silvester, and I want to talk to you a little bit about pain in the ball of your foot. We get a lot of patients with pain in the ball of their foot and that’s usually a neuroma or something of that nature. A neuroma is a swollen nerve between two metatarsals. The portal nerve is trapped between two bones on the sides, a ligament on top and the floor on the bottom. Usually it’s people who are wearing a thin-soled shoe that doesn’t have a lot of cushioning, so the nerve gets repetitively compressed and it causes the nerve to swell up.
The traditional treatment, when I first started practicing, was to remove the nerve, and that really, to me, doesn’t make a lot of sense. When you remove the nerve, almost always the patient will grow another neuroma. In fact, it’s almost 100%, unless you take great pains to bury the nerve into the muscle, and there’s not a lot of muscle on the bottom of the foot where you can bury the nerve.
Nowadays, we do several things. First of all, steroid injections can be very helpful at taking care of nerve pain for long periods of time – many years. Secondly, we can perform thermal nerve destruction, which is where we insert a probe, about as big as a needle, and freeze the nerve, which makes it stop hurting. The other thing you can do, if those all fail or if you want to go directly to something a little more aggressive, you can actually take the ligament that’s on top of the nerve and remove it, so that the nerve has a place to go and is not always getting pinched. This can be very effective at decreasing nerve pain.
Also, shoe gear modifications can be helpful. If you wear a good arch support, that can take a lot of pressure off the ball of your foot and decrease the pain in the area of the neuroma. Wearing a softer shoe, like a tennis shoe that has a lot of cushion on the bottom so that the bottom of the toe box, where the two metatarsal heads and the ligament are in the shoe, can also be very effective at lowering pressure on your nerve.
Try those things, and if everything else fails, you can give us a call at the Next Step Foot and Ankle Center, and we can take a look at the next step to get you back on your feet and alleviate a lot of the pain you’re having on the ball of your foot. Thanks for listening.”