Golf Doctor
(orthopaedics)

Be Kind to Your Feet. A proper fitting shoe can save you from foot pain

Michael Leighton, M.D.

Dear Golf Doctor:I have foot pain. My right foot hurts between the balls of my third and fourth toes. It's worse after walking and really doesn't bother me in the morning. It killed me after I wore my new black pumps. What is it?&emdash;Laurette Ross, WPBDear Laurette:I guess that must have been you I was following last Saturday&emdash;those greens were torn up! What is it about feet? I wrote an article two months ago about stress fractures in the foot and everybody and their brother is asking me foot questions. There are many painful feet out there! I guess the reason stems from the fact that: a) we have two of them, i.e. twice the potential for problems and b) some of us are overweight and really give those dogs a pounding. Think of it; the average person walks between one and two million steps a year! Quite the potential for abuse, eh? (That's for our Canadian friends).Anyway, this problem seems to be worse after activity, weight-bearing and shoe wear (especially narrow shoe wear). The pain around the balls of the third and fourth toe is most commonly caused by something called a Morton's neuroma. This is a swelling of a nerve that branches just as it approaches the balls of the foot (metatarsal heads). The swelling is caused by pressure of the two metatarsal heads against the nerve. The nerve gets compressed, gets inflamed, gets larger, gets compressed again, more inflammation and the cycle continues. As Arnold said in Kindergarten Cop, "It is not a tumor!" It is really just inflammation, or swelling, and is frequently reversible.The first action to take is: get rid of the narrow shoes! Try this: Stand on a piece of white paper and draw an outline around your foot. Next, put one of those pumps over the footprint and trace the outline. You will be amazed that your foot actually fits into that shoe! This is precisely the cause of most forefoot problems - tight shoes. So, in order to relieve the side-to-side pressure on your feet, get shoes with a wider toe box. Most walking shoes or sneakers have sufficiently wide toe boxes. If your golf shoes are too tight, many manufacturers have wider width shoes.If the wider shoes don't work, then the next concept is to relieve the pressure on the nerve. This is theoretically accomplished by spreading the metatarsal heads apart by placinga metatarsal pad just before the balls of the feet in all of your shoes. These pads are commercially available from Hapad. Placement is crucial and success improves with compliance. Consult your podiatrist or orthopaedist about this.The final two options available to painful Morton's neuroma are steroid injections and surgery. The steroid injections are placed on or near the swelling of the nerve and, combined with wide shoes are extremely successful. One major caveat: Steroids injected into the subcutaneous tissues can cause fat atrophy and thinning of the skin over the affected area. This can be unsightly and, in extreme cases, prone to injury and infection. Make sure the person giving the injection knows what he/she is doing. Surgery is nearly 100% successful. It is, however, surgery. Regional anesthesia is all that is required and protected weightbearing is required for 1 to 4 weeks. Expect to be spiking those greens in a month or so!

Michael Leighton, M.D. is an avid golfer who specializes in orthopaedic surgery and sports medicine. He can be reached at Atlantis Orthopaedics, 561-967-4400 or by e-mail at KNEESURG@aol.com