What hurts?
Some possible conditions • Foot Pain – Top of Foot – Forefoot – Proximal Forefoot
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Neuroma -
High Instep
Some possible conditions • Foot Pain – Top of Foot – Forefoot – Proximal Forefoot
A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth toes in the ball of the foot. The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, causing symptoms.
Normally, there are no outward signs of a Morton's neuroma, such as a bump or skin changes. The most common symptoms are:
• Persistent burning or sharp pain in the ball of the foot may radiate (spread out) into the toes.
• Having the sensation of a pebble or marble under the forefoot when walking.
• Pain is typically between the base of the third and fourth toes, but it can occur between the second and third toes as well.
• There may be numbness or tingling in the toes.
• Problems with shoes are common. High-heeled shoes can aggravate the neuroma. Tight, narrow shoes also aggravate it by compressing the toe bones and pinching the nerve.
The exact cause of a Morton’s neuroma is not known, but current research suggests it is likely the result of entrapment (compression or squeezing) of the common digital plantar nerves. Compression of the nerve in the web space may trigger swelling and cause abnormal tissue to form in and around the nerve.
Many people can achieve lasting relief with a combination of shoe modifications, orthotics, anti-inflammatory medications (e.g., ibuprofen or naproxen), and/or corticosteroid injections. Initial management of a foot neuroma typically involves choosing more appropriate wider shoes (i.e., a wide toe box) with lower heels. This enables the bones to spread out and may reduce pressure on the nerve, giving it time to heal. Custom made orthotics or metatarsal pads/bars added to your shoes may help relieve irritation by changing the location of forces on the forefoot and separating the bones, which reduces the pressure on the neuroma. While over-the-counter anti-inflammatory medications may help, a localized cortisone injection can reduce the swelling and inflammation of the nerve quickly, bringing some relief.
A high-arched foot, also known as a Cavus foot, is much less common than a flatfoot, but it can cause more pain and trouble walking—particularly if it’s connected to a neurological problem. A high arch on the inside of your foot creates a “high instep.” This can make fitting shoes difficult. It can also lead to other concerns because most of your body weight is loaded on to your heels and the ball of your foot, rather than be distributed evenly over your entire foot.
With time, the uneven distribution of body weight heavily concentrated on the heel and forefoot that we see with a Cavus foot, can lead to a number of symptoms. The most notable symptom is pain. The pain typically is felt in the heel, ball of the foot or on top of the foot – the instep. As a result, you may have trouble fitting into some shoes and notice redness on top of your feet after wearing shoes. Additionally, you may notice, your toes start to change shape (hammer toes/claw toes are common), and calluses/corns may appear under the feet or on the tops or tips of toes. Sometimes the foot tilts to one side, too, which destabilizes the limb and may increase the odds of spraining your ankle. Frequent ankle sprains may be related to your high arches!
Cavus high-arched feet can be your natural foot shape that you’re born with, but often it is the result of a neurological disorder. Cerebral palsy, Charcot Marie Tooth disease, polio, muscular dystrophy, and spina bifida are all conditions that may cause your arches to develop higher than normal. Although most often hereditary, there are number of reasons why your arches may seem excessive, such as having the following shape / biomechanical pathology - • Metatarsus adductus (“C-shaped” foot) • Forefoot valgus • Plantarflexed first metatarsal • Excessive curvature of the external arch (pseudoequinus) • Excessive inclination of the heel bone
A thorough biomechanical exam by a Canadian Certified Pedorthist or Registered Chiropodist is important to better understand the biomechanics of your lower limbs. Your primary care professional may also order x-rays. Treatment depends on if the arch is rigid or flexible but focuses on addressing any biomechanical pathology through functional correction or accommodation. This can be done with Orthotics and appropriate shoes. Shoes that are easy to get into and accommodate for a higher instep are ideal. However, no off-the-shelf shoe can properly address or support an excessively high arch. This is where orthotics are key. Also, any calluses or corns need to be trimmed and offloaded by a Chiropodist or Footcare Nurse. Finally, stretching and strengthening with physical therapy can help address balance issues and some gait disturbances.
