Expert: Dr. Marc Katz - 4/16/2009

Question
Dr. Katz,
I have been having foot pain in an isolated spot in between the metatarsal head of my third and fourth metatarsal bone. Although my podiatrist diagnosed it as a neuroma, he also said that it is a bit lower on the foot than most neuromas. We have done three injections over the past seven weeks, and the pain is not completely gone. Then yesterday a second podiatrist in this practice saw me and did some checking of the nerves in both feet. He prodded and hit the nerves on the insides of both ankles. And then today, I have a tingling weird pain on the nerve on my left foot and a dull aching pain in the same place on my left foot as the pain has been on my right foot for these seven weeks...obviously, I am extremely frustrated. I am a very active runner as well as a teacher and coach so I am on my feet a lot.  I would appreciate any insight and/or suggestions you could give me. Thanks.

Answer
HI Mike,

The dr was pushing the tibial nerve in the ankle area, also known as the tarsal tunnel.  This is the main nerve before there is branching toward the toes.  Irritation of this area can cause pain further down the line.  I would consider an US or MRI to see if a neuroma is identified.  These are not always perfect tools however a good start.  You could also consider a nerve conduction study to identify if there is any abnormality of the electrical conduction of the nerve. Have they tried orthotic devices?  If you do indeed have a neuroma or nerve disorder, I would recommend cryosurgery before considering the more common open surgery.  See my cryosurgery site below.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com

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