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Extreme foot pain

Dr Nieter –
I’ve noticed a pain on the top of my foot, between the bones.  It’s at a very specific spot.  It can’t be touched without sending me thru the roof.  It doesn’t look particularly swollen or red.  It doesn’t hurt to walk on it.  It just hurts like the dickens to touch. I was looking online, and the pain sounds like a metatarsal stress fracture?  I’m wondering if I did it when I almost fell while walking on the cobblestones while in Barcelona.

Will acupuncture help, or do I need to get the diagnosis from my doctor to know what I’m dealing with before I try acupuncture?
– In Pain in Sacramento

Dear In Pain in Sacramento,
Certainly could be a stress fracture but it is more likely to be a Morton’s Neuroma with the symptoms that you mention.

Neuromas are not truly a tumor as the name ‘neuroma’ would suggest. They are actually bundles of fiber or fibrous tissues that grow around a nerve and so grow between the toes where the nerve runs. Technically this is a perineural fibroma (around the nerve growth of fibrous tissue). Sometimes these fibrous tissues contain calcifications.  I have a big neuroma in my right foot that i developed from teaching Tai Ji in my driveway at 6 AM every day while barefoot. At one time it was very painful.  t is still there but I no longer have any pain since getting acupuncture and acupressure.

The stress fracture would be more evident if you press on the bone; while a neuroma hurts when you press between the toes, or if the toes create pressure, because the hard calcium deposit is being pressed into the nerve. OUCH! Stress fracture generally hurts to stand on.

Other possible, but less likely possibilities are:  Capsulitis which is inflammation of the capsular ligaments around the joint, arthritis, or bursitis which is inflammation of the water filled cushioning sack around the joint.  There are many other lesser possibilities.

You can go either way as far as the sequencing of treatment.  If it is a stress fracture then acupuncture can speed healing quite a bit.   Best would be electro acupuncture on a micro current device with mixed frequencies, such as alternating 2/100 hertz at 4 second intervals in biphasic mode, around the affected area.  Micro current at this frequency raises localized ATP levels (the direct energy producer of the body) and is phenomenal for healing damaged tissue.  I have seen it reduce healing time by haIf.

If it is a neuroma they are a little more difficult, but I have seen pretty good success, including my own case.

If you have insurance that covers it, I would have your MD do films of it.  In most cases I would actually recommend a podiatrist rather than an MD for this, as all a podiatrist does is feet.  About a 99% chance that they won’t do anything for a stress fracture.  Probably won’t do anything other than possibly a cortisone type injection if it is a neuroma.  The cortisone will shut down the inflammation short term but it is not likely to heal it and does have side effects.
Even though you probably won’t get or want the treatment, it is worth it for the diagnostic imaging.

There are also herbal formulas and topical tinctures that can help with either condition.

1. Get some films done.
2. Get some electro acupuncture
3. Bring the diagnostic info to your next visit and I will suggest formulae.
1. Stand barefoot, or sit with you feet on the ground, on grass, dirt, or in a pinch concrete, for a minimum of 10 minutes per day.

One more thing: In most cases the neuroma does not have calcific qualities so it won’t show up on x-ray.  It might be inferred from joint spacing net very hard to tell.  Cheapest way to visualize a neuroma would probably be an ultra sound.  MRI would be most accurate, but you probably won’t get one.

X-ray will probably show a stress fracture but not always, as they are difficult to see on X ray.  They are usually non-displaced and don’t give a large signature, especially if it is recent. An older stress fracture would have more time for bone healing so it would have more calcium deposited, making it easier to see on the x-ray.

I am personally familiar with this problem also. I have broken my left foot (non-neuroma) three times.  In each case the first X-ray was negative and then showed the fracture later.  The first time I broke it stepping on someone’s foot on the first play of the first game of a football season.  Severe pain with every step but I played on it all year because it “wasn’t broken,” and also because I have not always exhibited good sense!

– Dr. John Nieters, L.Ac. DAOM, FABORM

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