Foot Pain Treatment

Adventitial bursitis is a fluid sac that forms in the fat pad under the ball of the foot after injury. On ultrasound, these spots may look blurry or like tight pockets of fluid. They usually squash under pressure and look dark (hypo echoic). More complex pockets can look patchy and mixed.

Joint effusions are pockets of fluid in the joint. On ultrasound they look black (anechoic) and squash under pressure. They show best on the top of the toe-base joints. Overgrowth of the joint lining shows up as a thick lining. Extra blood vessels and worn spots in the bone may also be there.

A Morton’s neuroma comes from wear and tear on the interdigital nerve (the nerve between the toes). That damage wraps the nerve in scar tissue (perineural fibrosis). On ultrasound it often looks like a dark, egg-shaped lump, though its shape and brightness can vary. Intermetatarsal bursitis is a swollen fluid sac between the toe bones. It shows as a dark or black zone in a web space that is normally bright. It usually sits above the nerve, but sometimes wraps around it. Over time, this pocket can turn patchy and mixed. When we press on the web space during the scan, a neuroma barely squashes and a bursitis squashes easily (note: a complex bursa can look like a neuroma). Treatment options include an ultrasound guided cortisone or alcohol injection.

Common causes of forefoot pain include joint inflammation (arthritis, capsulitis & synovitis), plantar plate tears, tendinosis (“tendinitis”), bursitis and Morton’s neuroma. A Morton’s neuroma forms when scar tissue builds up on a nerve between the toes, called the interdigital nerve. In Morton’s entrapment, that nerve (also called the common plantar digital nerve, or intermetatarsal nerve) gets pinched. Each step, as your weight rolls forward and you push off, the ball of the foot presses the nerve against the front edge of a ligament that ties the long foot bones together (the transverse intermetatarsal ligament). It is most common in women, and high heeled shoes get the blame. The pain is often severe and feels like an electric shock. People often describe some or all of the following: “It feels like my sock is wadded up under my foot,” “cramping,” “numbness,” “burning,” “radiating sensations into the adjacent toes,” “the inability to walk barefoot on a hard floor,” and “tingling.” Others say it feels like a pebble in their shoe or like walking on razor blades.

Symptoms includes: pain when standing or walking, often after only a short time. The pain varies a lot from person to person. Some people feel shooting pain in the facing halves of two toes. Burning, numbness and pins and needles (paresthesia) can also happen. Most people with Morton’s entrapment hurt when we press on the sole between the ends of the long foot bones.

Radiofrequency nerve treatment has been used for over 10 years to treat long-standing pain. After numbing the skin, we place an electrode into the tissue at the painful spot. An electric current runs through it and makes heat. That heat destroys the nerve fiber that carries the feeling of pain.

A provider skilled in pain procedures performs Radiofrequency ablation. You are placed in the right position for the procedure. A grounding pad (diathermy pad) goes on your thigh, and the shot site is cleaned. We inject a local anesthetic around the nerve that is causing your pain. Once the nerve and area are numb, a fine needle is placed near the nerve. Imaging (ultrasound or fluoroscopy) confirms where it sits.

EPF is an outpatient procedure. It takes about an hour and is done at a hospital or a same-day surgery center. With special tools, we release the inner band of the plantar fascia (the thick band under your arch) that is causing your pain. After the procedure, you go to a recovery area. As your foot heals, new tissue fills the gap where the fascia was cut. That lengthens the fascia and eases strain when your foot moves. For best results, see your doctor as told over the next few weeks or months. Physical therapy or stretching is often prescribed to help recovery. Shoes with good support are a must for long-term recovery.