Plantar Forefoot Pain
This is commonly associated with hallux valgus (bunions), claw/hammer toes and localised nerve entrapment conditions called Morton’s or intermetatarsal neuromas.
Each of these conditions can be addressed surgically should conservative methods of treatment prove ineffective.
Neuromas (forefoot nerve entrapment)
These are very common to the forefoot (front part of the foot) but can be difficult to diagnose and are often misdiagnosed. Neuromas present clinically, with a wide range of signs and symptoms. They may be first noticed as a very intermittent sharp shooting pain in the forefoot and at times into the lesser digits (small toes of the foot). As the condition progresses this pain becomes more intense and more frequent. Patients often experience their symptoms more often or to a greater extend in tighter fitting footwear so women will often present to our clinic. As the condition becomes more severe burning is experienced to the plantar forefoot (ball of the foot) with sharp shooting pains into the lesser toes (usually the 3rd and 4th toes and less of the 2nd and 3rd toes) with a description of nerve type pain (ie-paraesthesia) including numbness. In the early stages neuromas can be managed very well non-surgically. Effective forms of treatment included wider more stable shoes, prescription made foot orthoses (with or without metatarsal padding) and injection therapy (local anaesthesia with/without corticosteroid). Topical and or oral anti-inflammatories or analgesics (pain killers) can be useful temporarily but are rarely useful in the long term. Larger and more severe neuromas may often only be resolved definitively with surgery known as a neurectomy procedure.
In this technique the disease portion of nerve is resected. This leaves an area of permanent numbness, which gradually reduces in size over time so it becomes barely noticeable. Usually patient have numbness affected the relevant toes by the time they require this form of treatment. Numbness between the affected toes is an effective diagnostic technique to assess for the presence or otherwise of a neuroma.
Please click below (video five) for a brief explanation about neuromas and to see a simple example of how surgery can be used to treat this condition.