EP #10: Uncovering the Secrets of Neuromas: Navigating Foot Pain with Dr. Lauren Dabakaroff

Step lively and say goodbye to foot woes as Dr. Lauren Dabakaroff unravels the mysteries of neuromas—a condition you might not know by name, but one that could be the culprit behind that pesky foot pain. Dr. Lauren, an expert in the field, walks us through the signs and symptoms of this common nerve swelling, often misinterpreted as a simple ache. Picture the sensation of strolling on marbles or feeling like your socks are forever bunched up—these are the tell-tale experiences many endure without realizing a neuroma might be at play. 

We also tackle the root of the problem—your shoes! Dr. Lauren stresses the significance of proper footwear, shedding light on how our choice of high heels and tight toe boxes could be squeezing more than just our style. Listen as she shares invaluable preventive tips to stave off this unwelcome guest and the importance of not ignoring the early whispers of discomfort. Whether you're a fashionista, a marathoner, or simply someone standing all day, this episode is stocked with practical knowledge to keep your feet happy and healthy. With Dr. Lauren's guidance, you're on the right path to addressing foot pain with the care it deserves.

To learn more, visit: LMDpodiatry.com or contact (954) 680-7133

Transcript

Speaker 1: 0:02

Welcome to the LMD Pediatry podcast. Trust us to get back on your feet. Here's your host, Dr Lauren Devakarov.

Jeremy: 0:15

Hello everyone and welcome back to another episode of the LMD Pediatry podcast. I'm your co-host, Jeremy Wolff, joined by your host, dr Lauren Devakarov. Dr Lauren, so nice to see you again.

Lauren Dabakaroff: 0:27

Nice to see you too, Jeremy. Happy Thursday.

Jeremy: 0:31

Happy Thursday Excited. Off to Orlando tomorrow with a daughter to meet a friend of mine with his daughter. A little daddy daughter weekend up at SeaWorld Should be fun.

Lauren Dabakaroff: 0:41

Absolutely. I have no plans this weekend. Let's see if there's. I've been trying to go to Butterfly World with the kid. The weather has been weird, so hopefully we'll have good weather.

Jeremy: 0:52

Well, enjoy it. I haven't been to Butterfly World in ages, but it should be fun. So, topic for today, something that I had never heard about before. You mentioned it to me, but you did say it's very common, so I thought it would make sense to talk a little bit about it. So, neuromas what is a neuroma, and how does it develop in the feet?

Lauren Dabakaroff: 1:15

Okay, so hi everyone. So neuromas are swollen nerves, right? So the nerve is what gives you sensation in your foot. You have them all over your body. A swollen nerve is a neuroma. It's very common to have it in your foot because there are all these different nerves that supply sensation to your toes and your foot, both superficially and deep. And then it's very common to have something called a Morton's neuroma, because between your third and your fourth toe there's a communicating branch of the nerve between the top of the foot and the bottom of the foot, and a lot of times that nerve tends to get compressed and that irritates the nerve and makes it swollen and thicken and it causes a lot of pain. It's one of the most common sources of when patients come in and say I have ball of foot pain or my toes feel different, or my toes are numb or have tingling in my toes. It's usually the third and the fourth toe and then that's where they have the pain and it's from the swollen nerve or their neuroma.

Jeremy: 2:32

Interesting. So, aside from the swollen foot area, the swollen area and the pain that's associated with that, are there any other common symptoms that are associated with the neuromas, and how do they typically impact daily activities?

Lauren Dabakaroff: 2:48

So a lot of patients present with that ball of foot pain. They feel like it's the same thing that everybody says they feel like they're walking on marbles, or they feel like there's a sensation of socks bunching in their feet. It's like a nerve sensation. Because the nerve is thicker than usual, it becomes a space occupying lesion. There's something in their foot and it's making it tight in there and that's why it's causing pain. So that's why patients feel like they're walking on a marble or they feel like there's something in their foot and sometimes they also get tingling in the toes.

Jeremy: 3:36

That makes sense.

Lauren Dabakaroff: 3:38

Yeah, so the ball of the foot, that's where they have the pain. And then they'll say I have, I feel like there's something in there, I feel like I'm walking on something, there's something in my foot, and that's usually the typical symptom. If they've ignored it for a long time and the neuroma gets bigger and bigger and bigger, that's when they start having the tingling in the toes and the numbness in the toes and it hurts in all their shoes. That's kind of what happens.

Jeremy: 4:07

Okay. So, if I understand correctly, I guess the inflammation or the neuroma, the heightened sensitivity of the nerve, ultimately leads you to kind of like a foreign body, some kind of foreign entity in the foot. Obviously, if it goes untreated it just gets worse, Like everything else. Right, Always try to prevent this beforehand. So are there any specific risk factors that predispose individuals to developing neuromas, or is this something that comes from increased activity? How does one you typically develop a neuroma?

Lauren Dabakaroff: 4:33

in the foot. So the most common cause of the neuroma is wearing the wrong shoes.

Jeremy: 4:39

Ah, back to the shoes again.

Lauren Dabakaroff: 4:42

So if you have a wide foot and you're wearing a shoe that's not wide enough to help, let you wiggle your toes and your foot, it can compress the joints to the point that the joints rub on the nerve and can create the neuroma. Another thing is flat shoes. If you don't have enough support at the ball of your foot, you know that nerve can get irritated. So most of the time it's just if you're wearing like shoes that are too narrow for your foot or shoes that have no support on the bottom, you can develop the neuroma.

Jeremy: 5:16

Yes, how are they typically diagnosed? Because I know I came in to see you recently for some pain I had in my foot. Sounds like I could have been something like this too, but it turned out to be a totally under the issue. How do you determine if somebody has a neuroma?

Lauren Dabakaroff: 5:30

specifically, so you never see it on X-ray. On X-ray you can see that maybe structurally, maybe the patients you know their bones are kind of kissing each other on the X-ray. So you know the bones might be pressing on the nerve.

Lauren Dabakaroff: 5:47

But the only way to confirm it is either by what they say or I take a look deeper with my ultrasound machine and I always, and I see you can see like this nice big white dot on the ultrasound machine and that's a. You know, that's the thickened nerve. It usually should be a diameter of a thread and when I see it like, you know, four to five times its normal size, I know that it's a neuroma. I confirm it with an ultrasound. Or you know some patients, I send them for an MRI, depending on their insurance. So that's kind of how it's diagnosed. But even before I confirm it, I always, you know, recommend treatment right away. And you know we go from there.

Jeremy: 6:30

So what are some common treatment options for the neuroma? And then if it gets too I guess if it gets too advanced or there's surgical options for it how does that work?

Lauren Dabakaroff: 6:44

So I usually start my first line of treatment, as I usually try, you know, a steroid injection to the nerve and what that does is it decreases a lot of the swelling and inflammation associated Cause you know, as the neuroma gets bigger it starts irritating all the surrounding muscles and tendons and joints. So that helps a lot with the pain. And then if that doesn't work, you know I pair that with change of shoes and orthotics and things like that, and if that doesn't work then there is a surgery to remove the neuroma. I do that maybe once a year if needed. It's not a surgery, I do every day Because I'm able to manage the pain and get rid of the neuroma with these injections and shoe change and orthotics and things like that.

Jeremy: 7:38

Is that a procedure that you actually conduct in your office, or do you need to go to like a hospital environment to do that?

Lauren Dabakaroff: 7:43

No, I do it in the hospital For a-. Okay for pretty much any surgical procedures for the most part you go to the hospital. There are more advanced techniques, like I've seen these pediatrics that they like in the office. They go in and they have some fancy machine and they make an incision, go in and use the machine to burn the nerve, like with some crazy machine in the office. But I don't know, I don't do that.

Lauren Dabakaroff: 8:09

It's like things exist. You know there's obviously a lot of things you can do for it, but I've never had to get to that point. There are also special alcohol injections that I do for severe cases. Alcohol injections yeah it's called sclerosing injections and it's basically dehydrated alcohol that essentially burns the nerve with an injection, and those also help keep my patients out of the operating room. Interesting.

Jeremy: 8:44

Aside from footwear, are there any other tips or recommendations or advice you can give to prevent issues like this from occurring?

Lauren Dabakaroff: 8:57

I mean for neuromas. It's nothing you can really. The only way you can prevent a neuroma is wearing the right shoes and wearing supportive shoes, but it's not something that you know like you're a runner right. So you have. I gave lots of tips and tricks how to prevent running injuries. A neuroma is not an injury. It's just something that develops over time. Sensitivity, yeah. Yeah it's just something that develops over time with the use of poor shoe gear.

Jeremy: 9:29

Are there any stretching good? Like, if you have a neuroma, is it good to stretch it or you don't want to do that because it'll probably hurt more?

Lauren Dabakaroff: 9:37

There's nothing too stretch. You can't stretch a nerve. Okay, just make sure that the shoes are wide enough for your foot, that you're wearing the right shoe size.

Jeremy: 9:47

See, it shows how much I know. Here I'm talking about stretching nerves. I don't know what's going on.

Lauren Dabakaroff: 9:50

No, no no, I mean there's some like chiropractic techniques, like you know, pulling the toes and kind of cracks the joint. We space around the neuroma. But it's not. It's really just shoe related. Neuroma is one of those things that you just get it from the shoe If you wear the wrong shoes, like, for example, I have a neuroma in my foot. I have one, but for me it's asymptomatic, unless I go cycling, when I ride a bike, when I go, when I go spinning, or if I ride a bike, my third and fourth toe go numb. It's not painful, right. So for me it's pretty asymptomatic, only when I aggravate it.

Jeremy: 10:32

So I was going to ask about that. So how important is it for somebody for, like, early intervention or proper management when they get into like, at what point should they look at this and say this is a problem, I should get it fixed?

Lauren Dabakaroff: 10:43

or in your case where. Right, so like if your toes go numb probably a sign you got a problem right.

Lauren Dabakaroff: 10:50

Yeah, it's a sign that there is something going on. So toe numbness is probably the number one sign and ball of foot pain is also pretty high up there with the signs and symptoms of neuromas. Like with, you know, I hate spinning, you know. So for me I just don't spin and I don't feel my neuroma. But I think over the years I've probably went away with wearing my orthotics and I haven't really spun lately to know if my neuroma is still there. So you know it's the numbness and the ball of foot pain that's usually the telltale sign of a neuroma. You come in, I diagnose, I evaluate treatment plan and then it's really just about wearing the right shoes. I always recommend orthotics or special pads for the balls of your foot that take pressure off the nerve.

Lauren Dabakaroff: 11:42

And then if, after like a few months, the nerve just doesn't get better, that's when we talk about surgery and things like that. But just to come and see me, if your toes are numb and the ball of your foot hurts with everything, whether you're running or you're walking, and it's just when it doesn't go away, you definitely have to come in and get a diagnosis for sure.

Jeremy: 12:06

Yep can never hurt, as I learned from personal experience. When I came in to see I was having pain in my foot, stopped running for a couple of weeks, came in to see you, you fixed me right up. You gave me some cool inserts for my shoes. You recommended I get some. What were they called? The ankle sleeves? Yes, and then icing the feet and I've been back running again and I still have a little discomfort here and there, but it's not prohibiting me from running and it doesn't hurt when I run, which is important as well. So thank you for that, dr Lauren. I appreciate it. You got me back on track. Yes, kudos to you. Yes, all right, cool, cool. Anything else that you'd like to leave our listeners with? Regarding neuromas?

Lauren Dabakaroff: 12:45

For you know, just if you feel that, if you feel like you're walking on marbles, if you feel like something is inside your foot, if your toes are going on when you do activities, if you have pain in the ball of your foot, more often than not you definitely have to come in and see your local podiatrist. And you know, get an official diagnosis and try to treat it, because if you don't treat it it will get worse and the neuroma will get bigger and then sometimes it gets so big to the point that you actually need surgery. You know so. You don't want that to happen, so don't ignore it. Pay attention to your feet, listen to what your foot is trying to tell you and, you know, take care of them. Wear the right shoes all the time. Shoes, you know, wear the wrong shoes. There are like half of the reasons my patients come in to the office because they get all these different foot aches and pains.

Jeremy: 13:40

Yes, speaking of shoes, it's probably time for me to get a second pair. I've been running with those Brooks now for months upon end. I think it's good to have another topic for another day, but it's good to have a variety of shoes when you're doing a lot of activities in them, for sure. All right, good deal. Dr Lauren, always a pleasure seeing you have a wonderful weekend and I will look forward to see you next time. Everyone, thanks so much for tuning in and we will catch you all in the next episode. Everyone, take care. Have a great day. Bye.

Lauren Dabakaroff: 14:09

Bye.

Speaker 1: 14:15

Thank you for listening to the LMD podiatry podcast. For more information, visit LMD podiatrycom or call 954-680-7133.