A female patient recently presented with a complaint of a painful neuroma in her foot. She relates a history of multiple treatments from foot specialists including steroid injections and absolute alcohol (No not the Russian type). She related metatarsal pads worsened it. She complains she is unable to wear any shoe except a high heal shoe for relief! “And I Just Can’t Wear High Heels everywhere” she said. A friend of hers referred her to us to obtain our TC3-DR custom foot orthotic technology as it had completely relieved her friend’s neuroma.
High heels? I thought they were bad for my feet, you may think. What’s up with that? Well this is a perfect example of why I do not treat patients via what I call “Menu Treatment” for foot conditions. That is, typically, you will hear or read that the recommended treatment for neuromas are metatarsal pads, low heeled and wider shoes, soft inserts, etc. All of which may or may not help. In my experience, nearly any nonorthotic treatment seems to be a 50-50 chance of success.
In order to help her, I needed to perform a physical examination including a biomechanical examination. What I found was this patient’s big toe joint was not functioning properly. When she walks, her big toe joint is not ready to flex when it should. This causes her foot to attempt to flatten out or pronate much more than it should when she propels herself forward. This not only causes a strain in her low back but also the front of her foot to be positioned in what we call a floppy, unlocked foot position. Instead of her foot being able to be in a locked or rigid position to propel her forward, the floppiness causes the metatarsals or bones in the front of the foot to rub and pinch on the nerve. This leads to inflammation and swelling of the nerve, thus the pain.
So how do high heeled shoes help her? They help by positioning the foot in a more supinated or locked, non-floppy position so she can propel with a rigid forfoot and thus not allow the bones to pinch the nerve. (They also help positon the big toe joint to flex easier when it is supposed to, relieving strain on the lower back. Although, the high heal may or may not aggravate the low back from the increased lumbar arch with wearing high heels).
The history of high heels helping her is further evidence that if we position the entire foot in a more ideal position with a TC3-DR custom molded foot orthotic, her feet will be ideally aligned. The orthotic will not only improve her big toe joint function, helping her back and reducing arthritis buildup in the joint, it will provide the rigid formation of the foot at the ideal time of gait-push off or propelling forward. This will eliminate the original cause of the neuroma.
By eliminating the cause, along with massage of the inflamed area, orthotics will enhance normal healing of a painful nerve condition without surgery or injections.
For more information, please visit www.ArchMastersTN.com.
David J. Sables, D.P.M., C.Ped.