Pain causing Plantar Fasciitis & Morton’s Neuroma

Why does my foot hurt?

A painful foot can be debilitating and prevent people from participating in activities as simple as standing or walking.  This can be caused by trauma, overuse, or conditions causing inflammation involving any of the bones, ligaments or tendons in foot. Arthritis is the most common cause of pain in the foot however inflammation in the nerves and fascia can be just as debilitating.

What are the common non-arthritis causes of foot pain?

Plantar Fasciitis

What is Plantar Fasciitis?

Plantar Fasciitis is an inflammation of the thick band of connective tissue that runs along the sole of your foot.   It normally helps support the shape of your foot when standing and is the most common cause of heel pain.  

 

This condition can be extremely painful especially with the first few steps in the morning, and may feel like you’re walking on a golf ball. 

Foot Pain

Who gets Plantar Fasciitis and what causes it?

Plantar Fasciitis affects people of all ages however is more common in individuals between 40-60 years.  Males and females are both as likely to get the condition and can occur in both feet simultaneously.  

You are more likely to develop plantar fasciitis if you are overweight, have been wearing inappropriate shoe wear, lack flexibility in your calf muscles or participate in activities that require a lot of standing or walking on hard surfaces. 

The cause of Plantar Fasciitis is often unknown.  Overuse and repetitive microtrauma due to excessive pressure over the fascia cause it to tear and degenerate resulting in heel pain. 

What are the symptoms of Plantar Fasciitis?

How do you diagnose Plantar Fasciitis?

Dr. Chow will take a thorough medical history and physical examination to delineate the nature of the pain, evaluate the degree of functional impairment and consider any other possible causes of pain in the foot. 

Imaging is required to rule out other causes of pain.  Weight bearing x-rays of the foot commonly show a heel spur however this is usually not the cause of plantar fasciitis.  MRI is used to assess the soft tissue in the foot. 

What is the likely course for Plantar Fasciitis if not surgically managed?

Foot Pain

Plantar Fasciitis is a self-limiting condition meaning that it generally resolves without surgery.  90% of patients with plantar fasciitis have a spontaneous resolution to symptoms within 6-9 months. 

Surgery is only indicated if the pain is prolonged pain failing all non-operative measures.  Surgery can be unpredictable, often disrupts the stability of the foot and provides inconsistent results, therefore it is reserved for only the most severe cases.  

What are the non-operative treatments for Plantar Fasciitis?

Non-operative management for plantar fasciitis is the mainstay of treatment with 90% of patients obtaining a spontaneous resolution within 6-9 months.  

Treatment may modalities include:

When does Plantar Fasciitis require surgery?

If the pain has not resolved despite non-operative treatments surgery is often required to release the plantar fascia.

Morton's Neuroma

What is a Morton’s Neuroma?

A Morton’s neuroma is a benign thickening of the tissue around a nerve leading to the toes.  This usually occurs between the third and fourth toes and feels like a pebble in the shoe with an associated numbness and pain in the ball of the foot or toes.  

Who gets a Morton’s Neuroma and what causes it?

Morton’s neuromas are more common in middle ages females and usually occur in one foot. The cause is usually due to excess pressure on the nerve due to the narrowing of the space between the toes resulting in thickening and scar tissue formation.

What are the symptoms of Morton’s Neuroma?

Foot Pain

How do you a diagnose Morton’s Neuroma?

Dr. Chow will take a thorough medical history and physical examination to delineate the nature of the pain, evaluate the degree of functional impairment and consider any other possible causes of pain in the foot.  

Morton’s neuroma is often a clinical diagnosis however imaging is often required to rule out other causes of pain and confirm the neuroma.  Xray, MRI and Ultrasound may be ordered by Dr. Chow depending on clinical examination. 

What is the likely course for a Morton’s Neuroma if not surgically managed?

20% of patients will have a resolution of symptoms with non-operative management.  It is difficult to recognize the patients that will be successful with non-operative measures and all attempts at conservative treatment should be initially trialed.

What are the non-operative treatments for a Morton’s Neuroma?

Non-operative treatments should be trialed for at least 3 months prior to considering operative intervention.  

Non operative measures include:

Foot Pain

When do I require surgery for a Morton’s Neuroma and what does it involve?

Surgery is considered after 3 months of failed non-operative treatments.  Surgery involves cutting out the compressed nerve and surrounding scar tissue.  This has an 80-90% success rate but result in PERMANENT NUMBNESS in the affected toes.

What to expect after Morton’s Neuroma surgery?

Morton’s Neuroma surgery is generally done as a day surgery procedure.  You will go home in a post-operative shoe with pain relief and advised to elevate the leg are 1-2 days.

Dressings are to remain dry and intact until your first post-operative appointment. Your sutures will be removed after 2 weeks and scar massage and desensitization commenced.  You should be able to return to a normal shoe at 2 weeks and full activities at 6 weeks.

Potential complications of Morton’s Neuroma surgery

All surgical procedures involve inherent risk of complications.  However, these risks are generally uncommon and quite infrequent.  These include anesthetic complications, wound infections, recurrence of the neuroma, injury to blood vessels supply the toe, chronic regional pain syndrome and blood clots 

Patients can minimize the risk of complications by carefully following post-operative instructions.

About Us

At Care First Orthopaedic our team of highly experienced surgeons provide comprehensive treatment and management for all orthopaedic conditions. Our comprehensive services help you achieve better bone and joint health to sustain an active lifestyle.

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