OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Dr. Robert Hume

Painful pinched nerve responds well to injection therapy


Injections eliminate foot pain and need for surgery

By Robert Hume, DPM, FACFAS
Chippewa Valley Orthopedics
& Sports Medicine, Eau Claire

A neuroma is a painful condition that results from pinching the nerve in the ball of the foot. The name suggests a tumor, but it is actually a benign growth that results from irritation, pressure or injury. It is much more common in women, and it's no surprise that tight shoes or high heels aggravate the problem. Patients usually complain of pain between the third and fourth toes, and describe the discomfort as burning, tingling or numbness. Relief may be found by removing the shoe and rubbing the forefoot (ball of the foot.) Early in the disorder, walking barefoot is more comfortable than wearing shoes.

The exact cause of a neuroma hasn’t been determined, but it is probably related to irritation or pressure. It is often seen in runners and occurs quite frequently with activities that concentrate the weight on the forefoot. There is no outward sign such as a bump or discoloration over the area. When examined by your podiatrist, there may be a clicking of the nerve between the bones of the foot when the forefoot is squeezed. This maneuver will reproduce the discomfort.

Conservative treatment would be to avoid high heels or tight fitting shoes and wear shoes with thick, shock absorbing soles. Applying ice to the affected area also reduces the inflammation of the nerve. Over-the-counter pads that cushion the forefoot may be beneficial. If conservative measures fail, more aggressive treatment may be necessary. Cortisone injections can provide relief for a time. A common treatment has been surgically cutting (excision) the affected part of the nerve. This has proven to be very successful, and has a relatively short recovery period.

Now, a new treatment offers relief without surgery. A series of alcohol injections is used to destroy the nerve. While surgical excision was previously quite common, it now seems to be unnecessary in most cases.

The injection therapy is performed by injecting a small amount of a combination of alcohol and a long-acting local anesthetic into the neuroma. A series of seven or eight injections is performed over a period of two to three months. Patients generally tolerate the injections very well, and there is no need to be off from work or to avoid daily activities. The treatment has little or no risk and none of the downtime associated with surgery. Surgery may still become necessary if the injection therapy fails, but the need for surgery has been dramatically reduced.

Conservative treatment is more effective if it is started early. Left untreated, the pain only becomes more progressive as the neuroma enlarges with repeated pinching. Alcohol injection therapy may reduce, if not completely eliminate, your pain. If you're wondering whether your forefoot discomfort is due to a neuroma, see your podiatrist.

For more information, or to schedule an appointment with Dr. Hume » 715.832.1400/800.322.1747, Chippewa Valley Orthopedic & Sports Medicine or visit www.cvosm.com