Can toe pulling beat ‘high heels’ pain in the foot?
MORTON’S neuroma may not be life-threatening, but it can prove deeply painful — it’s often compared to standing on a pebble.
the foot pain, sometimes caused by years of wearing high heels, is caused by the nerve that lies between the metatarsals, the long bones in the feet, becoming trapped and then thickening.
there is no cure — and the first line of treatment, insoles in the shoes, is largely ineffective for most people, while steroid injections to reduce inflammation and pain give only temporary relief. But could chiropractic offer a new option?
Normally used to help with problems with the back, chiropractic traditionally focuses on manipulating the spine
When it’s used for Morton’s neuroma, it involves energetic tugging of the toes — the idea is that this will release any stiffness that might have caused the metatarsals to tighten and move towards each other, rubbing against the nerve. Podiatrist David Cashley has worked alongside chiropractors in his practice near Dundee for the past 20 years and decided to train in chiropractic after seeing the positive results it could have.
‘I was seeing a lot of patients with Morton’s neuroma, but didn’t have a fix for them — while the chiropractors had the fix, but seldom saw Morton’s neuroma patients,’ he says.
He published a study of 38 Morton’s patients he had treated only with chiropractic in the Journal of Chiropractic Medicine in 2015. He said that after six treatments, 79 per cent were painfree, while a further 10 per cent experienced a minor discomfort only after a long walk. However, 5 per cent experienced worse pain than before. All of those involved had previously tried other treatments, such as steroid injections, without success.
He is now conducting a follow-up trial at Queen Margaret University, near Edinburgh, involving more than 50 patients. It will compare the outcome over a year of only having steroid injections against just having manipulation.
Michael O’Neill, of the College of Podiatry, says it may have some benefit.
‘Manipulation may help improve foot function and this may help in the early stages (as it takes the pressure off the nerve),’ he says. ‘However, I don’t think that it would get rid of the neuroma.’
ESTIMATES suggest that between 3 and 30 per cent of the population have a Morton’s neuroma and four out of five sufferers are women. the exact cause is unclear.
typically, symptoms include an ache that starts in the ball of the foot between the third and fourth toes. there may also be shooting pain up the affected toes that can become chronic.
Normally, the first treatment tried is an orthotic insole. steroid injections can reduce inflammation around the nerve. these are not without drawbacks, such as skin damage.
After that, there is little choice other than surgery to remove the nerve. But in up to 30 per cent of cases, the surgery doesn’t work — and pain can even return on the severed nerve end.
‘I always start doing the easiest things but 20 per cent of patients do not gain long-term relief from these so are willing to try surgery,’ says Michael O’Neill.