Ask Dr Gary: Crowded toes beg for mercy

Take care of your feet because you will miss them when they're gone.

For the past few months I've had pain in my right foot. At first it feels like a pebble in the front of my shoe, but by the end of the day it's unbearable. The pain and the numbness go away when I put my feet up.

I haven't had foot problems before and don't wear tight shoes. What is going on and how do I get rid of it?

Pain in the forefoot, or metatarsalgia, is very common, especially in middle-aged women. High-heels are by far the biggest cause, but anyone can get it, especially those wearing tight-fitting work boots, ballet shoes, ski boots or other restrictive footwear.

Any shoe with a heel that pushes weight forward can compress the front of the foot. The pencil-shaped metatarsal bones, a continuation of the toes and which run through the forefoot, get crowded together, pinching the soft digital nerves alongside them.

The space between the second and third toes is where the pain is typically felt. Bony compression can irritate the nerves so much they develop a sheath of scar tissue that puts constant pressure on them. This is called a Morton's neuroma, a misnomer since it's not a nerve tumour, but is plenty painful nonetheless.

Metatarsalgia can be treated with rest. Wide and flat-soled shoes are a first step in preventing pain. Losing weight also takes pressure off the forefoot.

Oral anti-inflammatories provide short-term relief, as do massage, icing and non-weight-bearing exercise in the pool. Next, orthotics, shaped footbeds and cushions made of cork or plastic, spread weight off the centre of the forefoot on to the heel, arch and first toe.

Persistent Morton's neuroma can be treated with anti-inflammatory injections, sclerosant injections which kill the nerve, or even surgery. See your GP for a diagnosis, as other conditions can be mistaken for metatarsalgia, most commonly stress fractures of the metatarsal bones.

Gary Payinda M.D. works as an emergency physician and would like to hear your medical questions. Email drpayinda@gmail. com. (This column provides general information, and is not a substitute for the medical advice of your personal doctor.)