Recently, an emergency patient visited us for neck and back pain that resulted indirectly from foot neuroma surgery. She had visited a podiatrist who had said the MRI confirmed a neuroma on the bottom of the feet and suggested surgical correction. She was initially able to get back to exercising until a few months later, the neuroma and its pain returned. A neurologist at a well-known hospital said the procedure was done improperly and had to be redone. After two months of recovery and then an infected scar, she visited our office on an emergency basis with neck and back pain.
Was there a different approach that could have avoided the pain, infections, and back issues that resulted in the two surgeries?
One of the problems with our currently overspecialized system which has become so procedure-orientated is that other options may never be presented to a patient desperate for a solution.
Our current system incentivizes procedures instead of simpler solutions. Often, simpler solutions are available however the typical script to rehab with the same exercises everyone else is doing often does not work because one person’s reason for a neuroma is often not the same as the next person’s reason for developing one.
The most common thing I find with patients who have neuromas is problems in the pelvis and legs and as a result, reduced mobility in the back of the ankle.
When walking, if there is a lack of posterior ankle mobility due to tight fascia and joint tightness in the back of the ankle, the person’s weight will be shifted onto the forefoot resulting in the metatarsals falling in, a thickening of the tissues, more stress on the toes and the development of a neuroma.
Things most likely to exacerbate the phenomenon are shoes that are too small and a history of lower and upper back problems involving gait, and the way we walk.
In the case of the woman our office saw, when she arrived, one foot had a boot on with the foot elevated and the other had a device on her shoe designed to level her hips as she attempted to walk. Is it any surprise that her awkward gait was now exacerbating or creating lower back and neck problems?
While she had relief of pain on her first visit, a noticeable improvement in her ability to walk occurred after manipulating both her ankles which had little or no mobility. Follow-up visits resulted in an improved ability to bear weight on the still-heeling post-infective foot.
I was very careful to avoid the area of the healing scar that was previously infected.
Could this scenario with all its anxiety and suffering have been avoided?
Chiropractic sports physicians may have been a good first choice for care. Chiropractors think and diagnose holistically and would have taken a deep history on this patient.
Ultimately, neuromas are caused by alterations in gait and are the symptom of these alterations. The problem, can be in the foot, the hip, the back, the neck, or be simply how we have adapted.
Looking at the foot without the context of how one joint affects another can result in situations such as this one.
Chiropractors would perform a deep history, an examination of the patient’s gait, their ability to move, the shoes they are wearing, the sizing of the shoes, and the mobility in the feet.
The treatment would have consisted of manipulation to the feet, spine, and ankles as needed, soft tissue treatment to the thickened and stiff tissues around the ankles, and exercises to improve gait and strengthen the feet and the tissues that have caused the neuroma to develop. It is common for a patient to experience relief of foot pain and the effects of the neuroma, while they also experience improvements in how they walk and function. This is because in many cases, the entrapment of the nerve is relieved by improving function in the area, improving foot function, and reducing the stress on the forefoot during gait.
Secondary problems such as lower back and even neck pain often improve as well as the patient functions better. Exercises help the patient strengthen and retrain dysfunctional muscles and movement patterns that have caused the problem.
This reduces impact to the ground, improves leg flexibility, and improves the way the patient feels and functions.
Often, foot orthotics are suggested to improve mechanical and structural problems. Instructing the patient on how to size a shoe is a simple way of preventing problems that have been caused by ill-fitting shoes in the future. Simply explained, foot orthotics level the hips and improve the function of the patient’s core.
Rather than performing a surgery that is high risk, and can have lifetime consequences for the patient, the chiropractic approach improves body mechanics naturally.
A conservative non surgical approach for foot pain is always a good first choice. As it has been said by numerous articles, who you visit first will determine your experience and costs for a health problem.
Keep it simple, think chiropractic first.
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