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Sometimes ‘killer heels’ is more than just a figurative term. If you have a neuroma, wearing high heels can mean a world of hurt.

The most common type, Morton’s neuroma, is an inflammation of the digital nerve, which is the nerve that travels through the foot to the toes. “The vast majority occur in the webspace between the third and fourth toes,” explains Dr. John Krause, an orthopedic surgeon on staff at Missouri Baptist Medical Center. “Neuromas are caused by tight shoes, high heels, repetitive standing on tiptoes, or anything that causes someone to repetitively push off with their toes,” he says.

Once the nerve is inflamed, wearing heels puts pressure on the ball of the foot, further irritating the nerve and causing discomfort ranging from a sensation of standing on a small pebble to intense, burning pain. Walking, running or standing for long periods also can put pressure on the forefoot, causing symptoms to arise. The pain usually subsides with rest.

“If you notice this type of pain, and it doesn’t resolve within a couple of weeks, it’s a good idea to stop wearing heels and see your doctor,” says Dr. Michael Weiss of St. Louis Podiatry. “If you notice redness or swelling (in addition to pain) see your doctor right away, since this can be a sign of something other than a neuroma.”

A definitive diagnosis may involve X-rays and an MRI in order to determine whether the pain is caused by a true neuroma or a problem with the foot’s bones or tendons. In some cases symptoms can be caused by bursitis or inflammation of the toe joint. Stress fractures, ganglion cysts and other less common conditions also may cause forefoot pain. “Morton’s neuroma isn’t a condition we see primarily in older people. It’s a condition we tend to see in active adults,” says Dr. John Holtzman, a podiatrist with Missouri Foot and Ankle.

Holtzman recommends orthotics as a first treatment in most cases, which ‘offloads stress on the the metatarsal interspace and helps spread metatarsal heads apart.’ Some patients find over-the-counter orthotics helpful, while others do better with custom orthotics. Anti-inflammatory medications may subdue symptoms, and cortisone injections into the nerve can calm inflammation when oral medications are not enough.

“Surgery is performed when nonoperative treatments fail to permanently relieve the symptoms,” Krause says. “Some patients will repeat injections or other treatments; others will elect to have surgery when the first injection wears off. It is important to try nonoperative treatment before surgery because nonoperative treatment frequently will solve the problem. Also, the medical literature reports that surgical treatment for neuromas is successful only 85 percent of the time. The 15 percent failure rate is not because the nerve wasn’t excised—it was because the nerve wasn’t the problem to begin with.”

Surgery removes the affected nerve, leaving an area of numbness between the third and fourth toes. “This numbness is rarely problematic, and it lessens with time,” Krause notes. “An alternative is to simply release the intermetatarsal ligament (the offending ligament) and not excise the nerve. This has a less predictable outcome. I prefer to excise the nerve as it causes very little problem after surgery.”

The bottom line is that neuromas are not dangerous or crippling, and they can be successfully treated. So if those heels are ‘killing your feet,’ take steps to find a solution.