Some days are weirder than others and I thought last Wednesday was going to be one for the books. On my daily schedule was a new patient. Her name was Miriam and she said she was coming to see me about a painful aroma. For a podiatrist such feet are sort of an occupational hazard. Fortunately bad cases are few and far between and are easily treated. But Miriam said she had a painful aroma. How bad could it be, I wondered. And what would make it painful? She was scheduled for the afternoon so I just had to wait and see.

When I returned from lunch Miriam was already in a treatment room. As I walked toward the room I did not sense any strange scents. The smoke alarm was quiet. I approached the room and gently opened the door. I was surprised. Sitting in the chair was a demure, pretty young woman. The only thing I could smell was a delightful perfume. She introduced herself and pointed to her toes. "I have a painful naroma", said Miriam with a decided southern drawl. From where she was pointing I surmised that she had, not a naroma, but a neuroma. The afternoon was saved.

I explained that neuromas are as painful as they are common. A nerve that supplies sensation to one of the spaces between the toes gets trapped and hurts. Nerves are similar to an electric cord. In an electric cord, a wire is surrounded by a rubber insulation that protects the wire. Similarly, a nerve is surrounded by an insulating cover called a sheath. The sheath similarly protects the nerve.

This is where the analogy ends. If the wire was caught under the leg of a chair, multiple movements of the chair might cut the wire. If a neuroma is caught between two metatarsal heads, the sheath gets thicker. This whole process is designed to protect the nerve. If the swollen nerve sheath gets too large, the pressure of any part of the foot causes pain. The pain is often described as a sharp needle-like pain at the base of the toes with occasional shooting pains that travel to the tip of the toe.

In short, Miriam has a trapped nerve that is causing pain. It is made worse by shoes that are tight at the ball of the foot, especially elevated heels. This is just the kind of shoe that Miriam needs to wear at work.

A neuroma will either get larger or stay the same size. Without outside help it rarely gets smaller. One possible way to shrink a neuroma is with cortisone. An injection of cortisone can sometimes eliminate the pain by shrinking the thick neuroma sheath.

Should the injections not work, Miriam will be looking at a surgical solution. Neuromas can be removed from the foot in an out-patient surgery performed under local anesthesia. The recovery is rapid with patients returning to tennis shoes within two weeks and leather shoes shortly thereafter. Neuroma removal results in numbness between the toes where once there was pain. The numb sensation seems to decrease after several months.

I explained all this to Miriam and administered her first cortisone injection. I believe she will do well with just an injection or two. I smelled success.

Dr. Michael Zapf is a board certified podiatrist with offices in Agoura and Thousand Oaks. For more information you can call his office at (818) 707-3668.