THE CLINIC: Treating Toe Pain, Kill the Nerve?

Thu, 13 Sept. 2012 - 8:54 p.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I have tried ice, pads, and double doses of o.t.c. pain killers. Nothing relieves the pain between my third and fourth toes. Please help, I’ve been in agony for 18 months!

 

Calvin Moriarty

Edmonton, NJ

 

ANSWER:

You may have metatarsalgia, which mimics Morton's neuroma. This condition is

caused by a metatarsal head which is a little lower than the other four heads

and receives more "banging" when running. A true Morton's neuroma is painful

with tight shoes and relief is obtained almost immediately by removing the

shoe and rubbing the affected area. If your shoes are not tight, think

metatarsalgia. If the forefoot is tight, get a wider pair of shoes. A good pair of

orthotics may help. A cortisone injection may help. A precise diagnosis will

help the most.

 

George Tsatsos, DPM

Elmhurst, IL

 

ANSWER:

If you have pain between the third and fourth toes, you most likely have a

Morton's neuroma. This is swelling or scarring of the nerve. Symptoms can

be cramping, burning, and/or feeling like an ice pick is being pushed between the

toes. Usually, relief is obtained by removing the shoe and massaging the

area. In addition to metatarsalgia, other possible diagnoses include a bursitis, capsulitis, ganglion cyst, or even a stress fracture. After 18 months, this should be looked at

by a podiatrist or foot and ankle orthopedist.

 

The neuroma diagnosis is confirmed by pinching the space between the third and

fourth toes while squeezing the foot from side to side. If your symptoms are

reproduced, that pretty much confirms it. It can be further confirmed by

ultrasound or MRI, but MRI is unnecessary in my opinion.

 

Treatment after this long is usually by cortisone injection to reduce the

size and scarring of the nerve. If you get some relief from the first, then

we may do up to three injections in the same area. We then try to prolong that relief with

an orthotic to lessen the pinching of that nerve. However, orthotics do not

always work to help neuromas. If the cortisone shot(s) do not help, then I

have used 4% dehydrated alcohol injections to chemically kill the nerve.

This is a great way to treat this without the disability of surgery. Surgery should

be the last resort to treat a painful neuroma.

 

Gene Mirkin, DPM, FACFAS, FACFAOM

Kensington, MD

 

 

DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.

(RUNNING & FITNEWS® July / August 2009 • Volume 27, Number 4)




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