• Dr. Jennifer Nicole Falk

3 Common Nerve Syndromes in the Foot



Do you ever get electrical pains in your feet or feel like you’re walking on a pebble, or maybe even have the feeling that you are always wearing socks or that your feet are constantly wading in water? If so, you may be dealing with a nerve condition.

Nerves are very sensitive structures that are not only responsible for muscle contraction, but also skin sensation. When they become compressed or irritated, they can cause a number of symptoms, including numbness, tingling, burning pain, or a pins-and-needles sensation. And unlike musculoskeletal conditions, nerve pains can be independent of position or activity, meaning that the symptoms can come and go regardless of what you are doing and some may even wake you up in the middle of the night.

Here is a short list of common nerve conditions that present symptoms in the lower extremity and how they can be medically managed. Of note, this list is not complete and if you feel like you are suffering with any of these conditions, or another neurological problem, you should contact the doctor, or your own healthcare professional, for a consultation.

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a compression of the nerve along the inside of the ankle. Causes for the compression may include trauma, a soft tissue mass that is pressing against the nerve, or a foot deformity that puts added strain on the nerve (e.g. flat foot deformity). Treatment should be aimed at treating the causative factor. If conservative treatment fails, surgical intervention may be warranted to decompress the nerve (1).

Treatment:

  • Anti-inflammatories (1)

  • Injections –

  • Local anesthetic injections – can help aid in the diagnosis

  • Steroid injections – can help decrease inflammation but should be used with caution around tendons

  • Proper shoe gear and orthotics (if the compression is related to a foot deformity) (1)

  • Surgery –

  • To remove the mass if present or to decompress the nerve if severely entrapped or if conservative care fails (1)

Interdigital Neuroma

A neuroma is an irritated or inflamed nerve within the forefoot. It can result from the long bones in the foot (aka metatarsals) rubbing against each other or from increased pressure placed along the bottom of the forefoot (e.g. while wearing high heels).

Treatment:

  • Proper shoe gear –

  • Limit heel height

  • Wear wider toe box shoes and shoes with cushion in the forefoot region

  • Pads –

  • Metatarsal pads can be worn to take pressure off the forefoot and the nerve

  • Injections –

  • Steroid injections can help decrease inflammation

  • Alcohol injections are used to decrease the size of the nerve

Peripheral Neuropathy

Unlike tarsal tunnel syndrome and interdigital neuromas, peripheral neuropathy typically presents with symptoms that are similar in both feet and is often the result of pathology coming from higher up in the body (i.e. back problems) or from another, more systemic or metabolic, process (e.g. diabetes). Again, the symptoms felt may differ from person to person, but may include numbness, tingling, or a burning pain in the feet.

Treatment:

Like tarsal tunnel syndrome, if the underlying cause is treated, the symptoms may improve. If the causative factor cannot be treated, or is unknown, treatment is often focused on improving one’s symptoms with different medications. It is important to have a thorough work-up first to try and determine both the cause and severity of the neuropathy because, whereas, some people may just have neurological symptoms, others may actually have a loss of sensation. When this happens, it is crucial to be educated on the importance of looking at your feet (and inside your shoes) on a daily basis to prevent open sores or wounds from resulting.

DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Should you have questions or concerns related to your health, please contact the doctor or your own healthcare professional.

References:

1. Banks, AS, Downey, MS, Martin, DE, Miller, SJ. 2001. McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery Edition 3. Lippincott Williams & Wilkins.


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