Summary of Chapter 12
If my feet hurt, I can’t think.– Abraham Lincoln
When Alexa, a 32-year-old party planner, came into my office, she immediately announced that her feet were on fire. Because she had an injury to her back, I wasn’t sure if the pain was a result of her sciatica or from her feet. She had been going for prolotherapy. Alexa had no relief to her burning soles. I had to differentiate between pain from the sciatic nerve and pain from her feet, so I sent her for a nerve conduction test. The results revealed that her foot pain was caused by a neuroma, which is a benign inflammation of a nerve in the ball of the foot or usually between two metatarsals. Alexa didn’t have just one neuroma; she had a double whammy of pain. I confirmed the neuromas with MRI scans.
The natural aging process can also play a role in making your feet feel like they’re scorching. The fat pads on your soles provide cushioning, but with each passing birthday they tend to become thinner. As this protective cushioning on your feet decreases, the pressure on the bones and nerves in this area (the plantar surface) increases. Fat is also important when it comes to controlling friction, so the less fat you have, the hotter your feet get. Solution: see “Pillows for Your Feet®” treatment later in this chapter.
A neuroma is a benign inflammation of an inter-metatarsal plantar nerve in the ball of the foot. It usually occurs between the third and fourth metatarsals causing burning between toes. This is known as a Morton’s neuroma, it is a benign focal expansion of the nerve. It is most likely caused by the repeated mild trauma of your normal foot motion over many years. Injury, irritation, or pressure that develops in your foot in your late 30s or 40s can exacerbate and also cause a neuroma. However, neuroma pain is also common in menopausal women due to hormonal changes in the body.
Pillows For Your Feet®: This is a wonderful adjunct to all of the above procedures to cushion the plantar surface of the skin under the neuroma and ensure more comfort for the long term. Here, FDA-approved filling agents, which are used for smoothing lines and wrinkles on the face – like Sculptra (which is poly-L-lactic acid) or Radiesse (calcium hydroxyapatite) – are injected into the ball of the foot. Results are immediate and the cushioning you feel is somewhat like walking on plush carpet. Since the filler material breaks down over time, you need injections about every three to nine months. Each procedure takes about 30 minutes. After this, you walk out of the office and feel extra cushioning immediately. By having a podiatrist pad the ball of your foot with an injectable filler, you can help to prevent neuromas by avoiding the pressure under the metatarsal heads. This, in turn, prevents trauma to the plantar musculature and tissue of the foot and therefore reduces the chance of an inflamed nerve, or neuroma, forming in the first place.
In this chapter of My Feet Are Killing Me Dr. Levine walks you through the following:
- What makes the bottoms of your feet feel like they are on fire?
- What causes damaged nerves in your feet?
- How can you stop the pain?
- What is a neuroma?
- Pillows For Your Feet®
- Real Patient Recap: Dr. Levine extinguishes Alexa’s flaming feet.