Total Pageviews



Sunday, December 26, 2021

Nerve Pain: Where Does It Come From?

     This image is of a T1 MRI section across the front of the right foot. Above my sensor marker, there is an obvious Morton's Neuroma that may be the complete cause of this patient's pain. Remember, we need to always ascertain if the pain is mechanical, inflammatory, neuropathic (like Morton's Neuroma), or a combination of these 3 factors. 
     In this foot, the section shows a typical low lying 4th metatarsal head with a very thin fat pad. This allows these plantar nerves on the bottom of the feet to get beat up too easily. The Morton's Neuroma can develop from this constant abuse over years. Why they begin to become symptomatic, when they are fairly large, is anyone's guess? 
     The onset of MRI technology now 35 years ago did teach us an incredible thing: Not all Morton's Neuromas hurt as they were found in patients where they never had nerve symptoms. Therefore, it is important, even in the face of an obvious MRI documented symptomatic Morton's Neuroma, that we make sure that the pain is completely driven by this enlarged nerve.
     The 3 sources of pain: mechanical, inflammatory, and neuropathic, also come the 3 avenues you can treatment patients symptoms: mechanically, anti-inflammatory, and nerve desensitization. So, we begin treatment with mechanical off-weight bearing pads, icing and contrast bathing, and neural flossing or acupuncture, etc. And, we follow these simple treatments with others based on the patient response and subjective feeling on what is helping. 
     Morton's Neuromas, as well as other nerve conditions like Tarsal Tunnel, have the added caveat that the majority of symptoms do not originate in the foot. This implies, and is very true, that treatment alone of foot nerve pain at the foot may not be successful. You typically should include in any Morton's Neuroma workup and treatment getting consults on the low back and spine in general. Think about the concept of Double Crush, where the nerve is only painful when irritated at least in two places, with no symptoms if you remove one of the two areas of irritation. 

No comments:

Post a Comment

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.