A quick and easy way to achieve anti-inflammatory measures on the forefoot is by using ice. By applying cold and ice to the foot, one can achieve temporary reduction of inflammation and pain. The effects of cold causes vasoconstriction, or constriction of the blood vessels reducing blood flow to the area. This reduces the mediators of inflammation found in the blood that cause localized inflammation. Ice has also been shown to temporarily reduce nerve activity. Very often, for most patients, we instruct patient to use ice at the forefoot twice a day, starting at the first visit.

We usually do not give a prescription to a physical therapist on the first few visits. We reserve physical therapy programs for when other conservative treatments have failed first. The reason for this is to avoid the inconvenience of going 2-3 times per week for therapy, as well as the expenses incurred. However, when other more convenient and less expensive conservative treatment options fail, we then will prescribe physical therapy.

Physical therapy involves supervised stretching and strengthening exercise activities, improved gait instructions, and physical therapy modalities. Physical therapy modalities are therapeutic ultrasound, electrical stimulation, paraffin application, cold therapy, heat therapy and laser therapy.

Sometimes, will prescribe phonophoresis or iontophoresis. In phonophoresis, we prescribe a prescription only topical steroid medication that is applied to the skin over the neuroma followed by therapeutic ultrasound, in order to enhance penetration of the steroid. Similarly, iontophoresis includes a prescription for topical steroid that is applied, followed by the use of electrical stimulation in order to enhance penetration of the steroid.