Biomechanical treatments for neuromas:
As we discussed in our neuroma causes page, one’s foot structure often contributes to getting neuromas. In particular, people who have arches that flatten out, or have flat feet, are prone to getting neuromas. There are various treatments that we perform to address flattening feet, called pronation, that leads to neuromas.
Arch strapping
Using a combination of tape and padding, we can support the arch in order to prevent pronation that leads to neuromas. This is often performed as one of the first lines of treatment for neuromas. We hold the foot in a neutral position with the patient sitting in the chair before the patient pronates when they weight-bear. We then apply tape to the foot in a manner such that it prevents flattening of the arch. Sometimes we incorporate padding within the tape to help support the arch. We encourage patients to keep the taping dry for 3 to 5 or sometimes 7 days so that it lasts longer. This is achieved by placing a bag over the foot when showering. Many patients purchase a shower bag that make this process much easier. Here is a link to one we recommend on Amazon.
Over-the-counter insoles
Another way to prevent the arch from collapsing or pronating, is to use over-the-counter insoles. A plastic insole placed inside the shoe can give some arch support. Depending on the shape of one’s foot, a generic over-the-counter insole may work for some people, while some will require custom molded orthotics. Often, if an over-the-counter insole works well, we will then make a custom molded orthotic that will last a lot longer, and work even better. By preventing the arch from collapsing, we can prevent some of the forces that cause neuromas. The two brands of over-the-counter insoles that we often recommend for our patients are Superfeet and Spenco. Both of these brands make multiple kinds of insoles. The ones that we recommend for neuroma are the more rigid, plastic ones, that are not just soft cushions. A more rigid insole supports the arch rather than just providing cushioning.
Custom molded orthotics
For the long-term treatment of neuromas, it is important to address the cause of the neuroma. As we have previously discussed, one of the main factors in developing neuromas is pronation of the foot, such that the metatarsal bones irritate the intermetatarsal nerve, causing it to get enlarged, inflamed and painful. The best way to treat pronation of the foot is by fabricating custom molded orthotics. In our office, we take a 3D-scan of the foot and send it to our laboratory. With a 3D-scan, our laboratory uses machinery to produce an exact replica of the bottom of the patient’s foot. This is called a “positive mold”. With this replica of the foot, our laboratory can then fabricate a perfectly fitting orthotic. We also send a prescription to the laboratory advising them on all the different parameters that go into making the orthotic. There are literally infinite ways to construct an orthotic. Some of the major variables include: angles at the forefoot, angles at the rear foot, density and flexibility of the materials used, cushioning and padding materials, height of the forefoot relative to rear foot, overall size and shape of the orthotic in order to fit into different kinds of shoes, and many more variables and decision making.
With decades of experience, and thousands of custom fabricated orthotics, we are very successful in making custom molded orthotics that treat neuromas, and any other problems of the foot. For neuromas, we often add a dispersion pad that pushes the metatarsal bones away from the nerve, at the same time as controlling the pronation of the arch.
Shoe gear changes
Unfortunately, often, the more stylish a shoe is, the worse it is for neuromas. We often recommend shoe gear changes to our patients to treat neuromas. These are usually for shorter periods of time and not forever. For females, we often recommend avoiding high-heeled shoes. A high heel shifts the weight forward onto the forefoot and puts more pressure on the neuroma. In general, we recommend using sneakers over dressier shoes for both men and women. Women’s stylish shoes often tend to be more narrow which puts more pressure from the medial and lateral aspects on the nerve. This also applies to some men’s shoes.
In addition, sneakers are more accommodative in order to fit insoles, both over-the-counter and custom molded orthotics. Sneakers also tend to have more cushioning inside of them. And lastly, sneakers tend to have a more accommodative curve to the sole which helps to alleviate forces on the forefoot as compared to a flat soled dress shoe.
For some patients, we recommend a rocker-bottom soled shoe that drastically reduces the amount the forces on the forefoot when walking.