Sensible non-surgical solutions for a painful foot neuroma.

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She said that her right foot pain began almost two years ago after wearing a flat sandal and the pain worsened over time.  She visited a podiatrist who sent her for therapy on her foot.   After a number of weeks of therapy, it was suggested that she had a painful foot neuroma which was responsible for the pain on the top of her 4th toe. She had the surgery and then went for a couple of months of therapy which helped reduce the pain but did not resolve it. A friend had suggested at the beginning of her journey that she consider seeing his chiropractor rather than a foot specialist.   Recently, she visited our office after a year and a half of expensive interventions that offered little benefit and was surprised that her foot was the symptom, rather than the problem. During our initial consultation, she denied having any back problems although she later admitted that sitting and working at home made the left side of her shoulder blade painful. She believed that was due to working at home during Covid-19. An evaluation showed she had a bunyon developing on the right foot which she said was not painful.  She also had torsion in the pelvis and was knock-kneed.  Her left side on right lateral bending had a noticeable restriction into her left shoulder and neck and her right rotation in her neck and lower back was restricted, but not painful. The typical pattern of compensation from an overpronated (foot where it falls in) left foot would be tight fascia (the tissues that surround all the tissues in the body) on the right lateral side which would increase the impact on the lateral side of her foot. This was confirmed during our examination. There was also reduced motion in the back of the foot and ankle which can cause a painful forefoot and result in neuroma years later. Treatment included replacement of her foot orthotics which were shown to be non-corrective, myofascial release of the tight tissues in the leg and pelvis, and manipulation of the foot, ankle, and pelvis.   The patient returned the second visit markedly improved and noticed her overall tightness that she considered normal for her had markedly improved as well. Sitting and working at her desk was much more comfortable than before.

What is a neuroma in the foot?

A neuroma as described by Wikipedia is when the intermetatarsal plantar nerve in between the toes has become entrapped, either by the soft tissues surrounding it or by the bony structures known as the metatarsal heads.  It has been described as being caused by shoes that are too small, or by high heels. Those who suffer from the condition can experience numbness or tingling and outright pain in between the toes or on the top of the foot  Most healthcare providers will evaluate the foot and its structures, however, a more holistic approach taken by chiropractors will include not only the foot but the knee, lower back,  hip, and ankle.   This is done because tight fascia and poor adaptation over the years may have resulted in increased impact when walking, reduced mobility in the ankle which will increase the load on the front of the foot.  Years later, the result is often bunyons and other mechanically painful conditions which may include knee pain, back pain, shoulder, and even neck complaints.

Was the neuroma the symptom or the problem?

When a painful foot takes this long and requires months of therapy and treatment, a good healthcare consumer should question the effectiveness of the care and accuracy of the diagnosis. A healthcare provider should also question the efficacy of what they were recommending. Chiropractors are trained holistically meaning we look at the entire clinical picture and manage it using a primary care approach to the musculoskeletal system. Chiropractic sports physicians also had additional training to properly evaluate and treat athletes who may experience foot pain and running injuries.   Most doctors will evaluate the injury, chiropractors evaluate the person and then understand the mechanism of injury.  This leads to more cost-effective care and better results while avoiding costly therapies, risky injections, and invasive procedures. Chiropractors are trained to not only look at the area of complaint but to understand the mechanism behind why you hurt and find a non-invasive drug free solution. There is no normal gait that describes how we walk.   There is a range of normal. Most of us have been taught that normal is not having pain and abnormal is experiencing pain.   Since we walk and look like our parents, we are likely to inherit their problems as well.   By the age of 6, we are walking more like adults and then we get taller, a woman's hips will become wider and the way we are used to feeding is our normal.   When we experience symptoms that do not self resolve, we consider this abnormal. The way we walk, also known as our gait is an adaptation e to our inherited body mechanics, any falls, injuries, and other things we have adapted to over the years. If you experience foot, ankle, knee back, shoulder, and neck pain, it is partly because of how you walk and move your body.   It is how you adapted. Poor movement patterns eventually develop resulting in pain. Perhaps, this is why foot pain, back pain, hip pain, and many other complaints we experience must be evaluated from the ground up, holistically.   Treatment must address the mechanism causing your painful condition (s), not just where you hurt.   If your problem is evaluated and treated properly, many potential future painful problems may never occur since you function better. Chiropractors are your one-stop-shop for understanding and treating what makes you hurt. For foot pain, who should you visit first?   All roads lead to the chiropractor.