WHAT IS A NEUROMA? 

Definition of NEUROMA

 : A tumor or mass growing from a nerve and usually consisting of nerve fibers; from New Latin

   First Known Use: circa 1847

A neuroma is a term generally used to describe a painful condition, also referred to as a “pinched nerve” or a nerve tumor.  It is usually a benign growth of nerve tissue that can cause pain, a burning sensation, tingling, or numbness between the toes and/or in the ball of the foot.

People who have neuromas can have pain that shows up between the toes while walking. They often try to find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having an object (like a pebble or a stone) in their shoe.

Some of the Symptoms are:

·         Pain in the ball of the foot when weight is placed on it.

·         Pain in the forefoot and between the toes.

·         Swelling between the toes.

·         Tingling and numbness in the ball of the foot

How Do You Get a Neuroma?

The exact cause for this condition is sometimes elusive and unclear and a number of things can contribute to the formation of a neuroma.

Deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. This type of foot often creates instability around the toe joints which may lead to the development of the condition.

Trauma might cause damage, inflammation and/or swelling of the nerve.

Improperly fitted or poor footwear can causes your toes to be squeezed together, which can cause problems.  Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.

Occupational or recreational repetitive stress can aggravate or create a neuroma.

How Can We Get Relief?

It is important that you see your podiatrist so that the condition can be properly identified prior to trying out anything to relieve an undefined condition.  Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important. Podiatric medical care needs to be sought at the first sign of pain or discomfort; if left untreated, neuromas tend to get worse.

But in general, the following can be helpful:

·    Footwear with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment can help to mediate the symptoms.

·    Wear shoes with thick, shock-absorbent soles and proper insoles that are designed to keep excessive pressure off of the foot.

·    High heels should be avoided whenever possible because they place undue strain on the forefoot and can contribute to a number of foot problems.

·    Use of over-the-counter shoe pads may relieve pressure around the affected area.

·    Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use of an ice pack can help to dull the pain and improve comfort.

·    For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own.

When conditions warrant podiatric medical treatment or surgery may be necessary to remove the tumor.

Treatment by Your Podiatric Physician

The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops. Your podiatric physician will examine and likely perform X-rays on the affected area. The exam is important so that a treatment plan that best suits your individual circumstances can be suggested.

Some of the possibilities for treatment include:

·    Padding and Taping:  Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma.

·    Medication:  Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the neuroma.

·    Orthotic Devices:  Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the condition.

When early treatments don’t seem to work and the neuroma progresses beyond the threshold for the above options, podiatric surgery may become necessary to remove the inflamed and enlarged nerve.  This can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks.

Your podiatric physician will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is managed with medications prescribed by your podiatrist.

Your feet aren’t supposed to hurt so it is important to schedule an appointment with your podiatrist at the first sign of pain or discomfort in your feet, and follow proper maintenance guidelines to ensure their proper health for the rest of your life.

If you are experiencing foot and ankle pain this is not normal.  Let Dr. Jacob, Dr. Miranpuri and our great staff help you.

Madison Podiatry Associates

In Sterling Heights, MI

1-586-997-5000

Or click on the link below to go directly to our contact webpage:

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SOME MORE CORNY JOKES

One evening after work Curt drove his secretary home after she was unable to start her car.  Not wanting to bother his wife, Maureen, he decided not to mention it to her.

Later that night Curt and Maureen were driving out to eat when Curt spotted a high-heeled shoe under the passenger seat.  Pointing to something out the passenger window to distract his wife, he picked up the shoe and tossed it out of his window.

They arrived at the restaurant a short time later and were about to get out of the car when Maureen enquired, 'Curt, have you seen my other shoe?'

TRUE NEWSPAPER HEADLINES (that maybe should have been written a little differently)

"WOMAN PRIED OUT OF WRECKED CAR WITH BROKEN LEG"

"HOSPITAL IS SUED BY 7 FOOT DOCTORS"

 What is the last thing you take off before you go to bed?

…………………………..Your feet- off the floor.

What has four legs but no feet?

………………………….A table

What do you call a dinosaur with stinky feet?

………………………..ex-stinked

What has 50 legs but can't walk?

……………………….25 pairs of pants

What would you get if you crossed a centipede with a parrot?

………………………….A walkie-talkie

How did the bubblegum cross the road?

………………………….It was stuck to the bottom of the chicken's foot.

Why don't centipedes play football?

…………………………By the time they get their shoes on, the game is over.

If you are experiencing foot pain or have unusual symptoms please remember that this is not normal. 

Contact us and let Dr. Jacob, Dr. Miranpuri and our great staff help to bring you comfort and relief.

Madison Podiatry Associates

Sterling Heights, MI

1-586-997-5000

Click on the link below for our “Contact Us” webpage:

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Ganglion(ic) Cysts

Origin of the Term:

From Late Latin: swelling; from Greek: cystic tumor, a tumor under the skin, on or near a tendon.

A ganglion cyst is a tumor or swelling on top of a joint or the covering of a tendon (tissue that connects muscle to bone). It looks like a sack of liquid. Inside the cyst is a thick, sticky, clear, colorless, jellylike material.                                                                         

Depending on the size, gaglionic cysts may feel firm or spongy. They can appear on your feet (as well as other areas of the body such as wrist and knees) and can make wearing shoes very difficult.

The cause of ganglion cysts is not known. One theory suggests that trauma causes the tissue of the joint to break down forming small cysts that then join into a larger, more obvious mass. Another theory involves a flaw in the joint capsule or tendon sheath that allows the joint tissue to bulge out. Another theory is excess stress is one area due to shoe rub or faulty foot mechanics (abnormal joint or tendon function). Abnormal stress can weaken the lining of the tendon or joint capsule, resulting in an “out-pouching”.

The ganglion cyst usually appears as a bump or swelling that can change in size and is normally soft. It may or may not move around and can be up to 1.5” in size. Ganglionic cysts are not considered cancerous growths and generally do not invade other structures. The swelling may appear over time or appear suddenly, may get smaller in size, and may even go away only to come back at another time.

Most ganglion cysts can cause some pain, but many are without symptoms except for appearance. If pain is present, it is usually a constant aching, which can be made worse by joint motion. If the ganglion cyst is connected to a tendon, there may be a feeling of weakness in that area of the foot.

Medical evaluation of the ganglion cyst is recommended whether or not you have symptoms. This way your foot doctor can indicate that you actually have a ganglion cyst and not something else.  This will keep you from worrying, and help you decide on the best treatment plan.

Your foot doctor may get further confirmation by using a syringe to draw out some of the fluid in the cyst or perform an ultrasound test. Magnetic resonance imaging or MRI can be used and is suitable for ganglions.

Aspiration has been used to treat the condition and usually includes placing a needle into the cyst, drawing the liquid material out, injecting anti-inflammatory agents along with other medications, and then splinting and dressing the area.

Surgical removal of the cyst is needed when the mass is painful, interferes with function (especially when your dominant hand is involved), or causes numbness or tingling of the hand or fingers.

Unfortunately, there is no assurance that a ganglion cyst will not return, even with surgery. If you compare aspiration/injection and surgical removal, in general, these cysts appear to return less often after surgery.

As with every type of surgery, there are some hazards to be thought about. Although rare, injury to tendons, blood vessels or nerves may occur. These can cause weakness, restricted motion, or numbness.

If you are experiencing foot pain or other unusual symptoms, please remember “This Is Not Normal”.

Please contact us and let Dr. Jacob, Dr. Miranpuri and our great staff help you:

Madison Podiatry Associates

Located in Sterling Heights, MI

1-586-997-5000

Click on the link below to access our CONTACT web page directly:

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BURN INJURIES TO THE FEET

Burns to the feet have been classified by the American Burn Association as major and are not to be taken lightly, since they are an important part of the body and we put them to hard and constant use.

Since we place huge demands on our feet, the healing process can be slowed down and delayed and can be somewhat difficult.

Below are just a few examples of how a burn can occur on the foot, (but there are many other ways they can happen):

1. Feet placed in scalding water by those of us who have no or little sensation and didn’t realize how hot it was.
2. People who have no or little sensation place their feet on or near a furnace and do not realize that their feet are burning.

3.       Work related injuries, in which scalding fluid or metals that accidentally come into contact with our feet.

4.       Kitchen accidents where hot fluids (like boiling water or soup) are dropped on a person’s feet.

There are different degrees of burns that you should be familiar with:

First degree burns (like a sunburn or mild heat burn) are red in appearance, very painful, and are very sensitive to hot and cold temperatures. These burns can heal without any complications, but since it is easy to get infections on your feet you need to have your doctor examine it.  This will help to to prevent any further issues (especially if you are diabetic).  

Second degree burns are those which are red but then also develop a clear blister. These are less painful once the blister has developed. If you have this type of burn, you need to have it examined by a doctor. When these burns are on the feet, taking antibiotics and dressing the burns are preventative measures that need to be taken to avoid complications.

Third degree burns are very serious. You must definitely seek emergency medical care and go to the hospital immediately if you have sustained this degree of a burn even though it may not be painful as you would expect. There are blood blisters that form in that area and the skin appears white.

A fourth degree burn is an extremely severe type of burn that causes damage to the muscles, tendons and ligament tissue. You must definitely seek emergency medical care and go to the hospital immediately if you have sustained this degree of a burn even though it may not be painful as you would expect.  Fourth degree burns can be caused from prolonged exposure to flames or even a high-voltage electrical shock. There may be some instances where the inner layer of skin closest to the muscle is partially or completely burned away, which may result in compartment syndrome. Compartment syndrome threatens both the limb and the life of the patient

Burns in diabetic foot patients can be a significant problem due to loss of sensation. Fast and effective intervention is always required as relatively small injuries can progress to ulceration and, in severe cases, lead to amputation.

Please remember that foot and ankle pain is not normal.  Please contact us and let our doctors (Dr. Jacob and Dr. Miranpuri) and our great staff help you.

Madison Podiatry Associates

In Sterling Heights, MI

1-586-997-5000

Or click on the link below to go to our contact webpage:

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NECROTIZING FASCIITIS

Recently in the news there has been a story about a young woman who had contracted a severe life threatening infection called Necrotizing Fasciitis while enjoying outdoor sports.

She apparently cut her calf while “zip lining” and fell into a river.  She was taken to the hospital and treated. The cut required 22 staples to close.

The following day she came back to the hospital’s emergency room in intense pain and was given a painkiller.

She went back to the hospital the next day and was given antibiotics, but by the next day she couldn’t move and had to be taken to the hospital again.

At that time the emergency room doctor diagnosed with her the flesh-eating bacteria called necrotizing fasciitis. She has had to have limb amputation but apparently is stabilizing.

Necrotizing fasciitis is an infection caused by bacteria. It can destroy skin, fat, and the tissue covering the muscles within a very short time. The word "necrotizing" means something that causes body tissue to die. When the bacteria enter the body - often through a cut or scrape - it grows and releases harmful substances that kill the surrounding tissue and disrupt blood flow. Once the tissue dies, the bacteria continue to enter further into the body and spreads.

The most common site for development of necrotizing fasciitis is lower extremities (such as feet, ankles and lower legs), abdomen, perineum and scrotum.

It commonly occurs in people whose immune systems are compromised as those with diabetes, malnutrition and HIV infection.

Necrotizing fasciitis was first described by a Confederate Army surgeon during the US Civil War. In 1883, another doctor documented necrotizing fasciitis in the certain regions of the body. Another physician later reported 20 patients he encountered in China in whom necrotizing fasciitis was caused by a certain strain of streptococcus.

There has been a reported case of an elderly diabetic man who developed necrotizing fasciitis of the feet and lower limbs along with bilateral gangrene of his feet. The condition was related to dipping his feet into hot water and massaging them after walking barefoot outdoors. This apparently led to a breach in the skin and allowed entry of the microorganisms, which resulted in severe necrosis of the muscles and tissues containing blood vessels and nerves. The result has been amputation of his feet.

The risk of getting this infection is higher if you:

Have a weak immune system.

Have chronic health problems such as diabetes, cancer, or liver or kidney disease.

Have cuts in your skin, including surgical wounds.

Recently had chickenpox or other viral infections

Use steroid medicines, which can lower the body's resistance to infection.

You can get necrotizing fasciitis when bacteria enter a wound, such as from an insect bite, a burn, or a cut. The microorganisms can enter into wounds that come in contact with ocean water, raw saltwater fish, or raw oysters. You also can get it through injuries from handling sea animals such as crabs. It can enter at an intestinal surgery site, or in tumors or gunshot injuries in the intestines or muscle strain or bruise, even if there is no break in the skin.

Bacteria that cause necrotizing fasciitis can be passed from person to person through close contact, such as kissing, or by touching the wound of the infected person. But a person who gets infected by the bacteria is unlikely to get necrotizing fasciitis unless he or she has an open wound, chickenpox, or an impaired immune system (such as diabetes).

The symptoms often start suddenly after an injury. You will need medical care right away if you have pain that gets better over 24 hours and then suddenly gets worse. The pain may be much worse than you would expect from the size of the wound or injury.

The infection can spread rapidly and quickly become life-threatening. You may go into shock and have severe damage to skin, fat, and the tissue covering the muscles. (This damage is called gangrene.) Necrotizing fasciitis can lead to organ failure and death.

Early treatment of necrotizing fasciitis is critical. The sooner treatment begins; the more likely recovery from the infection will occur and serious complications, such as limb amputation or death avoided. Treatment in an intensive care unit (ICU) at the hospital may be required.

Surgery that removes infected tissue and fluids to stop the spread of infection almost always is required. Removing limbs (amputation) or organs may be done to save the person's life, depending on how severe the infection is and where it has spread. Medicines, such as antibiotics are typically administered to try to destroy the bacteria causing the infection.

Procedures to treat complications such as shock, breathing problems, and organ failure may be performed along with hyperbaric oxygen therapy.

It is important to keep your feet and ankles well protected with the proper required foot-wear at all times.  This helps to minimize cuts, scrapes and bruises. Make sure you get your feet and ankles checked out regularly to make sure existing conditions are treated properly. To help prevent any kind of infection, wash your hands often, and always keep cuts, scrapes, burns, sores, and bites clean.

Madison Podiatry Associates

In Sterling Heights, MI

1-586-997-5000

Click on the link below to go directly to our contact webpage:

Contact Us