Neuromas
Pain under the balls of our feet can be caused by a multitude of reasons however a big culprit is our fashionable shoe gear (yes, I’m talking to the mean too!). Although the etiology can be our anatomy (like an enlarged nerve that’s getting pinched during walking [neuroma] or a long metatarsal) and not necessarily outside forces (like those Tori Birch or Hugo Boss shoes), they are usually dealt with in a similar linear fashion. Fist and foremost, your shoe wear has to be appropriate and functional. The next line of therapy usually includes physical therapy done both in the office and by yourself at home. Next are injections. These normally work great but mainly mask the symptoms avoiding the actual problem. If all of these modalities fail, surgery to repair the underlying problem is the last and most successful option.
In the case of neuromas, a small incision is made in the top of the foot and the neuroma (enlarged, irritated nerve) is excised. Patients with one or multiple long metatarsals (creating an abnormal metatarsal parabola) require a procedure that shortens the bone re-establishing a more functional foot. Another cause more commonly seen in the older population is fat-pad atrophy. This is where the fat under the balls of your feet thin over time. This lessens the shock absorbing ability of the soft tissues. The procedure performed in this case involves placing a synthetic tissue graft under the skin which provides the forefoot the cushioning previously lost.
