You’ve Got Some Nerve

It’s the New Year. Hope you had a ball. Actually, I can guarantee you had a ball. Two of them, in most cases. And at this point, if you’re like many of my NYC podiatry patients, you may be experiencing pain, numbness or other sensations in that area, which of course is the ball of the foot (oh behave!), due to your affliction with the painful and common Morton’s neuroma.

We have covered this one before in the most holy and sacred annals of this sacramental blog (not all blogs can make that claim), but it’s such a common condition that is also so treatable I figured it bears repeating. The nerves that provide sensation to the bottom of the foot originate ultimately from the sciatic nerve and the spine, and locally emerge from an area of the bottom of the heel that faces the other foot. From there they branch into a lateral branch, providing sensation to the 4th and 5th toes, and the medial branch which innervates - wait for it - the 1st, 2nd 3rd toes. The nerves run in between the metatarsal bones, which are the long bones of the foot, on their way out to the toes, thus providing a full report of the happenings of the bottom of the foot in its entirety. Because of the precarious position of the nerves between two long bones and lying in a space that can become tight with shoes, activity and life, they often become inflamed, to the point that a small ball of swelling can be observed microscopically or on MRI examination of the area. This manifests as a classic constellation of some or all of the following symptoms: pain, numbness, shooting pain into the toes, a feeling of walking on a pebble or a sock in the area or burning needle like sensations. The pain is usually exacerbated by tighter shoes (think pointy-toed high heels) and relieved by wider soft shoes (don’t think about those).   Any of the intermetatarsal spaces can be affected, although the most common location is between the 3rd and 4th toes due to a connecting branch between the two nerves that exists in this location.

Diagnosis is made based on clinical signs and can be confirmed by MRI or ultrasound. Treatment consists of wearing more comfortable shoes, corticosteroid injections, and if all else fails, surgical release or removal of the nerve- although the percentage of cases that require surgery is quite low, especially given the high incidence of the condition within the general shod population. And that’s good news, as this is something that I see daily in my NYC podiatry office.

So if you’re having a ball, or two that are not feeling like much of a party, it may be time to kick off the New Year’s heels. And if that doesn’t work, don’t be so stubborn, as bubbie would say, come in, it couldn’t hurt.

See you in the office.

Ernest Isaacson

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