What is causing the awful stabbing pain in my foot?

I HAVE a burning, stabbing pain under my middle toes and it’s becoming increasingly difficult to walk, especially if I’m wearing shoes. What could it be?

IT COULD be a sign of Morton’s neuroma – irritation or damage to the nerves that run between the long bones in the foot.

Sufferers usually describe a burning or stabbing pain, as if there is something sharp stuck under the ball of their foot, between the third and fourth toes, that can make walking difficult. Pins and needles or even numbness in the foot are also common, and it gets worse when wearing tight shoes.

It’s not always clear what causes Morton’s neuroma, although we know it is related to pressure or injury of the nerves in the area. Sports which are high-impact, such as running or jumping, may also lead to this nerve inflammation. It is more common in people who wear ill-fitting or high-heeled shoes, or have other problems such as bunions or flat feet.

In the first instance, doctors recommend resting and elevating the foot when possible, as well as regularly using an ice pack in the sore area. Switching to low-heeled comfortable shoes can help too.

But often this is not enough, in which case injections of antiinflammatory steroids might be worthwhile. Surgery, either to release the pressure on the nerve or remove it entirely, is also quite commonly undertaken on the NHS for this problem.

I HAVE suffered terrible insomnia for years and no amount of sleeping pills make any difference. My GP suggested I try melatonin. Could it work?

MELATONIN is a hormone released by the body that makes us drowsy and ready for sleep. Receptors in the eyes register low light levels and signal the brain to produce it.

Older people in particular are believed to produce low levels of melatonin, and this is why we sometimes prescribe a drug of the same name that contains a lab-made version of it.

Melatonin sleeping pills are licensed to treat insomnia only in people over 55 – they have been extensively studied and found not to work much better than a placebo or other, non-drug methods in younger patients.

We’d typically suggest middleage patients try it for a few months, just to help get things back on an even keel.

But, generally speaking, medications are never the longterm answer to insomnia, and patients often tell me that even strong sleeping tablets make little difference.

The evidence base for people suffering with chronic sleep problems suggests that rather than medication, psychotherapy should be the first line of attack.

Cognitive behavioural therapy for insomnia, or CBT-I, includes a range of treatments, such as sleep restriction, in which time spent in bed is limited, then gradually increased again.

Other methods include establishing a regular waking time and sticking to it no matter how little you’ve slept, or, if you wake in the night, getting out of bed and doing something boring like reading a dull book. Your GP should be able to tell you where to get CBT-I sessions, which are available both face-to-face in ordinary times and online.

These options can be taxing and they’re not a quick fix, but are much more likely to work in the long term than medication.

So it is always worth undertaking some simple measures first, to make sure your routine before bedtime is as conducive to sleep as possible. These include cutting out caffeine and other stimulants, and avoiding phones or computer screens – they emit a bright light which is believed to suppress natural melatonin production. Installing blackout blinds in the bedroom can also help.

FOUR years ago I developed a visible lump on the side of my neck, just below my jaw, which was found to be harmless – something called a branchial cyst. Doctors said there was no point in removing it, particularly because it was on the jugular vein which made surgery risky. But if I’m unwell it swells up and causes discomfort. Can anything else treat it?

A BRANCHIAL cyst is, in essence, a birth defect – a fault in the neck that develops while still in the womb.

Some of the tissues in the neck don’t join up fully, leaving a pocket known as a cleft sinus. Fluids can get trapped in this space, giving rise to a lump.

Although people are born with the problem, it usually becomes apparent only in late childhood or adulthood. Branchial cysts are harmless but, as with any lump, particularly in the neck of an adult, they should always be assessed with a scan to ensure they are not cancerous.

It is perfectly reasonable for many people with these type of cysts to not have any treatment, as they are not dangerous.

But the cyst is often next to or on top of very important and fragile parts of the neck, for example the jugular vein or large arteries, and therefore surgery may be considered too risky.

Whenever we consider surgery, the risks and benefits should always be carefully weighed up. Even the simplest operations come with risks from infection or the use of anaesthetic. So unless the cyst was causing very severe problems, for example, if it was regularly becoming infected or a very large lump was distressing to the patient, it would be left well alone.