When I last left you, my poor dear NYC podiatry patients, we were discussing the vicissitudes of pain in the ball of the foot. Since that time the foot still hurts, we are still walking, and it’s just a bit hotter. Time to be a bit proactive and talk about solutions to the problem. After all, anyone can complain about the problem, it takes a real tough New Yorker to complain about the solution too.
At the heart of this problem is a thin, fragile and slightly defenseless nerve that is wedged between the hard unforgiving metatarsal bones and even harder and more unforgiving shoes, ground forces and the challenge of defensively walking the streets of New York. So it’s rather unsurprising that inflammation of the nerve is such a common condition. And the treatments are generally directed toward reduction of inflammation.
The first step, in my NYC podiatry practice is typically a cortisone injection. Now friends, before you go and cast off this most sacred blog, hear my words and listen to my keyboard. Cortisone injections are more than just a bandaid, and I know so because I’ve blogged about them. Cortisone is a potent anti-inflammatory agent that reduces inflammation both within the nerve and the surrounding space, and combined with sensible shoes and- wait for it- orthotics, is typically curative. If, however, it is not, then the next step is a procedure called radio frequency ablation. Without betraying any gory details, this is an office procedure that uses electric current to significantly reduce the inflammation in the nerve, and carries a high success rate with minimal downtime. If all that fails the next step is an endoscopic release of a ligament around the nerve, a very quick outpatient procedure, also carrying a high success rate and minimal downtime. And finally there is the old gold standard- removal of the offending nerve. Obviously this carries certain risks and the procedure is only utilized when all else fails. The good news is very few patients reach this stage, and in the 6-7 years since I have been releasing the nerve, I have only had to resort to excision of the nerve in one patient.
So my young and young at heart friends, we have before us a very common and very treatable condition. The risks and benefits of each of the above listed procedures is too long and boring for this most holy blog, and can be elucidated in the warm and welcoming environment of your friendly local NYC foot doc. Now get out there and soak up the sun, it’s summertime!
See you in the office.
Ernest Isaacson
