Knowing Pain like the Back of Your Foot

Hushpuppies pestered by a painful neuroma may be anything but hushed. In fact, they may scream for attention! Interdigital neuroma is a medical term for a painful growth that sometimes occurs between two toe bones, usually of the third and fourth toes.

The problem stems from scar tissue that grows around and squeezes a small nerve that runs between the toes (the interdigital nerve). Women seem to be most affected by this condition, which typically starts after age 50. Tight and narrow shoes often make the pain worse.

This study is the first of its kind to look at the long-term benefits of neuroma surgery. The study considered the results of 66 people (74 neuromas) who had neuroma surgery. The preferred method of surgery is to make a small incision on the top of the foot, just over the neuroma. A ligament that crosses over the neuroma is divided, and the small nerves passing between the toes are severed.

Past studies done shortly after surgery suggest that the benefits of surgery worsen with time. Yet this study showed that 85 percent of all patients had either “good” or “excellent” satisfaction an average of five and a half years after surgery. Even though some patients still had some numbness or tenderness, it didn’t keep most of them from doing normal activities. Twenty-three people had mild problems resuming activities. Only two had major restrictions on what they could do.

The benefits observed by these authors have a firm, long-term footing. Surgical treatment of a painful neuroma through the top of the foot shows successful results more than five years later.

A Step Beyond Physical Therapy: Surgical Treatment of Heel Spur Syndrome

Heel spur syndrome is caused by sharp or bony growths on the heel. This condition can be treated with physical therapy, anti-inflammatory drugs, heat, cold, and rest. Usually, the pain goes away within three to four months. For some patients, however, the pain continues in spite of treatment. 

This article gives an alternative for patients who don’t improve with physical therapy. The authors describe a simple surgical technique developed in Cuba. The technique is done with an endoscope–a small camera-like device that is inserted into the hollow part of the bone. Using this method, doctors can find and remove bone spurs without making big incisions.

Thirty patients had this surgery five months after trying other types of treatment, including eight weeks of physical therapy. Eleven of the patients were male; 19 were female. The patients ranged in age from 20 to 60 years old. Eight had this treatment done to both feet, 30 days apart.

All of the patients had good or excellent results after surgery. By three months, the patients had little or no pain. They even returned to their normal activities.

One year after treatment, only five patients (14.7 percent) reported any pain. This residual pain was brought on by sports and resolved after going to physical therapy. 

Overall, this new surgical treatment was very successful, with few complications. There was no comparison group in the study to prove that this treatment was better than another. Still, endoscopic treatment seems to be a simple, cost-effective way to deal with heel spurs. The authors are working on a two-year follow-up, to study the results of this type of surgery over time.

On Target with Steroid Medication–A Heel of a Deal

The most common cause of heel pain is proximal plantar fasciitis (PPF). PPF involves inflammation in the tissues where the arch connects to the heel bone. Up to 10% of runners have it at some point in their running careers. The pain usually gets better with rest, anti-inflammatory drugs, and ice treatments. When it doesn’t, doctors may inject steroid medication into the sore spot under the heel.

These injections are not simple to do because it isn’t always easy to feel exactly where to put the injection. This may mean the doctor has to do the injection more than once to get the medicine into the sore spot. Steroid medicine tends to make connective tissue become soft. In the heel, repeated injections can actually cause the tissue to tear. Injections may even hurt the fat pad that sits just under the heel. That’s why it is especially important for the medicine to hit the sore spot.

For this study, doctors examined 14 patients with PPF. Their pain and swelling levels were measured before they got a steroid injection. Ultrasound images were used to guide the point of the needle into the heel. The patients’ pain and swelling levels were then tested again two weeks later and at three months.

The results show that ultrasound can help the doctor guide the needle into the correct spot on the heel. Every one of the patients in the study had significantly less swelling and pain when they came back in for a recheck. None of them showed any signs of damage to the heel pad.

Ultrasounds are affordable, radiation-free, and easy to use. This study indicates that ultrasound technology helps doctors guide needle placement in patients with PPF. The study also indicated that ultrasound can effectively help track progress in patients with PPF.

The Lighter Side of Preventing Overuse Injuries in Runners

“Pain free.” These two words sum up a desire of every runner. And thanks to a steady flow of helpful research, runners are better able to stay one step ahead of potential injury. Two new discoveries have recently been added to this growing body of knowledge. First, it has been found that runners who land with higher impact have a greater tendency toward overuse injuries. Second, runners are at risk if the foot isn’t correctly positioned to cushion the impact when it hits the ground. This can happen when the foot stays arched while in contact with the ground.

Normally, the foot will keep its arch until the moment the heel hits the ground. Then the arch lowers as the sole of the foot makes contact with the ground. This motion is called pronation, which is needed to help the foot absorb shock during impact. After pronation, the foot immediately starts to arch again as a way to power the next stride. If the foot doesn’t start to pronate as the heel hits the ground, the foot remains rigid, putting the runner at higher risk for overuse injury. 

The authors used a special platform to measure the forces and foot positions of two groups of runners. The first group had past problems with one or more overuse injuries. The other group had no history of injuries. Measurements were recorded while each person ran on the platform. People in the injury group showed higher forces on impact. Also, their feet were sluggish when moving from the arched to the pronated position. As a result, the authors recommend that injured runners slow their stride during training as a way to lessen the impact.

The authors recognized that training habits can also be a source of overuse injuries. But modifying training routines are only one way–and often an oversimplified way–to address the problems of overuse. The authors are convinced that foot alignment and the way the foot works mechanically while running are what determine safe training levels. They also hope that future research along these lines will offer other new and helpful ways to prevent overuse injuries before they happen.