EP #10: Uncovering the Secrets of Neuromas: Navigating Foot Pain with Dr. Lauren Dabakaroff

Step lively and say goodbye to foot woes as Dr. Lauren Dabakaroff unravels the mysteries of neuromas—a condition you might not know by name, but one that could be the culprit behind that pesky foot pain. Dr. Lauren, an expert in the field, walks us through the signs and symptoms of this common nerve swelling, often misinterpreted as a simple ache. Picture the sensation of strolling on marbles or feeling like your socks are forever bunched up—these are the tell-tale experiences many endure without realizing a neuroma might be at play. 

We also tackle the root of the problem—your shoes! Dr. Lauren stresses the significance of proper footwear, shedding light on how our choice of high heels and tight toe boxes could be squeezing more than just our style. Listen as she shares invaluable preventive tips to stave off this unwelcome guest and the importance of not ignoring the early whispers of discomfort. Whether you're a fashionista, a marathoner, or simply someone standing all day, this episode is stocked with practical knowledge to keep your feet happy and healthy. With Dr. Lauren's guidance, you're on the right path to addressing foot pain with the care it deserves.

To learn more, visit: LMDpodiatry.com or contact [phone]

Episode Transcript

Speaker 1 (00:02):
Welcome to the LMD Pediatry podcast.
Trust us to get back on yourfeet.
Here's your host, Dr LaurenDevakarov.

Jeremy (00:15):
Hello everyone and welcome back to another episode
of the LMD Pediatry podcast.
I'm your co-host, Jeremy Wolff,joined by your host, dr Lauren
Devakarov.
Dr Lauren, so nice to see youagain.

Lauren Dabakaroff (00:27):
Nice to see you too, Jeremy.
Happy Thursday.

Jeremy (00:31):
Happy Thursday Excited.
Off to Orlando tomorrow with adaughter to meet a friend of
mine with his daughter.
A little daddy daughter weekendup at SeaWorld Should be fun.

Lauren Dabakaroff (00:41):
Absolutely.
I have no plans this weekend.
Let's see if there's.
I've been trying to go toButterfly World with the kid.
The weather has been weird, sohopefully we'll have good
weather.

Jeremy (00:52):
Well, enjoy it.
I haven't been to ButterflyWorld in ages, but it should be
fun.
So, topic for today, somethingthat I had never heard about
before.
You mentioned it to me, but youdid say it's very common, so I
thought it would make sense totalk a little bit about it.
So, neuromas what is a neuroma,and how does it develop in the

(01:14):
feet?

Lauren Dabakaroff (01:15):
Okay, so hi everyone.
So neuromas are swollen nerves,right?
So the nerve is what gives yousensation in your foot.
You have them all over yourbody.
A swollen nerve is a neuroma.
It's very common to have it inyour foot because there are all

(01:39):
these different nerves thatsupply sensation to your toes
and your foot, bothsuperficially and deep.
And then it's very common tohave something called a Morton's
neuroma, because between yourthird and your fourth toe
there's a communicating branchof the nerve between the top of

(01:59):
the foot and the bottom of thefoot, and a lot of times that
nerve tends to get compressedand that irritates the nerve and
makes it swollen and thickenand it causes a lot of pain.
It's one of the most commonsources of when patients come in
and say I have ball of footpain or my toes feel different,
or my toes are numb or havetingling in my toes.

(02:22):
It's usually the third and thefourth toe and then that's where
they have the pain and it'sfrom the swollen nerve or their
neuroma.

Jeremy (02:32):
Interesting.
So, aside from the swollen footarea, the swollen area and the
pain that's associated with that, are there any other common
symptoms that are associatedwith the neuromas, and how do
they typically impact dailyactivities?

Lauren Dabakaroff (02:48):
So a lot of patients present with that ball
of foot pain.
They feel like it's the samething that everybody says they
feel like they're walking onmarbles, or they feel like
there's a sensation of socksbunching in their feet.
It's like a nerve sensation.
Because the nerve is thickerthan usual, it becomes a space

(03:15):
occupying lesion.
There's something in their footand it's making it tight in
there and that's why it'scausing pain.
So that's why patients feellike they're walking on a marble
or they feel like there'ssomething in their foot and
sometimes they also get tinglingin the toes.

Jeremy (03:36):
That makes sense.

Lauren Dabakaroff (03:38):
Yeah, so the ball of the foot, that's where
they have the pain.
And then they'll say I have, Ifeel like there's something in
there, I feel like I'm walkingon something, there's something
in my foot, and that's usuallythe typical symptom.
If they've ignored it for along time and the neuroma gets
bigger and bigger and bigger,that's when they start having
the tingling in the toes and thenumbness in the toes and it

(04:02):
hurts in all their shoes.
That's kind of what happens.

Jeremy (04:07):
Okay.
So, if I understand correctly,I guess the inflammation or the
neuroma, the heightenedsensitivity of the nerve,
ultimately leads you to kind oflike a foreign body, some kind
of foreign entity in the foot.
Obviously, if it goes untreatedit just gets worse, Like
everything else.
Right, Always try to preventthis beforehand.
So are there any specific riskfactors that predispose

(04:27):
individuals to developingneuromas, or is this something
that comes from increasedactivity?
How does one you typicallydevelop a neuroma?

Lauren Dabakaroff (04:33):
in the foot.
So the most common cause of theneuroma is wearing the wrong
shoes.

Jeremy (04:39):
Ah, back to the shoes again.

Lauren Dabakaroff (04:42):
So if you have a wide foot and you're
wearing a shoe that's not wideenough to help, let you wiggle
your toes and your foot, it cancompress the joints to the point
that the joints rub on thenerve and can create the neuroma
.
Another thing is flat shoes.
If you don't have enoughsupport at the ball of your foot

(05:03):
, you know that nerve can getirritated.
So most of the time it's justif you're wearing like shoes
that are too narrow for yourfoot or shoes that have no
support on the bottom, you candevelop the neuroma.

Jeremy (05:16):
Yes, how are they typically diagnosed?
Because I know I came in to seeyou recently for some pain I
had in my foot.
Sounds like I could have beensomething like this too, but it
turned out to be a totally underthe issue.
How do you determine ifsomebody has a neuroma?

Lauren Dabakaroff (05:30):
specifically, so you never see it on X-ray.
On X-ray you can see that maybestructurally, maybe the
patients you know their bonesare kind of kissing each other
on the X-ray.
So you know the bones might bepressing on the nerve.
But the only way to confirm itis either by what they say or I

(05:52):
take a look deeper with myultrasound machine and I always,
and I see you can see like thisnice big white dot on the
ultrasound machine and that's a.
You know, that's the thickenednerve.
It usually should be a diameterof a thread and when I see it
like, you know, four to fivetimes its normal size, I know
that it's a neuroma.
I confirm it with an ultrasound.

(06:15):
Or you know some patients, Isend them for an MRI, depending
on their insurance.
So that's kind of how it'sdiagnosed.
But even before I confirm it, Ialways, you know, recommend
treatment right away.
And you know we go from there.

Jeremy (06:30):
So what are some common treatment options for the
neuroma?
And then if it gets too I guessif it gets too advanced or
there's surgical options for ithow does that work?

Lauren Dabakaroff (06:44):
So I usually start my first line of treatment
, as I usually try, you know, asteroid injection to the nerve
and what that does is itdecreases a lot of the swelling
and inflammation associatedCause you know, as the neuroma
gets bigger it starts irritatingall the surrounding muscles and
tendons and joints.
So that helps a lot with thepain.

(07:06):
And then if that doesn't work,you know I pair that with change
of shoes and orthotics andthings like that, and if that
doesn't work then there is asurgery to remove the neuroma.
I do that maybe once a year ifneeded.
It's not a surgery, I do everyday Because I'm able to manage

(07:30):
the pain and get rid of theneuroma with these injections
and shoe change and orthoticsand things like that.

Jeremy (07:38):
Is that a procedure that you actually conduct in your
office, or do you need to go tolike a hospital environment to
do that?

Lauren Dabakaroff (07:43):
No, I do it in the hospital For a-.
Okay for pretty much anysurgical procedures for the most
part you go to the hospital.
There are more advancedtechniques, like I've seen these
pediatrics that they like inthe office.
They go in and they have somefancy machine and they make an
incision, go in and use themachine to burn the nerve, like
with some crazy machine in theoffice.

(08:05):
But I don't know, I don't dothat.
It's like things exist.
You know there's obviously alot of things you can do for it,
but I've never had to get tothat point.
There are also special alcoholinjections that I do for severe
cases.
Alcohol injections yeah it'scalled sclerosing injections and

(08:31):
it's basically dehydratedalcohol that essentially burns
the nerve with an injection, andthose also help keep my
patients out of the operatingroom.
Interesting.

Jeremy (08:44):
Aside from footwear, are there any other tips or
recommendations or advice youcan give to prevent issues like
this from occurring?

Lauren Dabakaroff (08:57):
I mean for neuromas.
It's nothing you can really.
The only way you can prevent aneuroma is wearing the right
shoes and wearing supportiveshoes, but it's not something
that you know like you're arunner right.
So you have.
I gave lots of tips and trickshow to prevent running injuries.
A neuroma is not an injury.

(09:19):
It's just something thatdevelops over time.
Sensitivity, yeah.
Yeah it's just something thatdevelops over time with the use
of poor shoe gear.

Jeremy (09:29):
Are there any stretching good?
Like, if you have a neuroma, isit good to stretch it or you
don't want to do that becauseit'll probably hurt more?

Lauren Dabakaroff (09:37):
There's nothing too stretch.
You can't stretch a nerve.
Okay, just make sure that theshoes are wide enough for your
foot, that you're wearing theright shoe size.

Jeremy (09:47):
See, it shows how much I know.
Here I'm talking aboutstretching nerves.
I don't know what's going on.

Lauren Dabakaroff (09:50):
No, no no, I mean there's some like
chiropractic techniques, likeyou know, pulling the toes and
kind of cracks the joint.
We space around the neuroma.
But it's not.
It's really just shoe related.
Neuroma is one of those thingsthat you just get it from the
shoe If you wear the wrong shoes, like, for example, I have a

(10:12):
neuroma in my foot.
I have one, but for me it'sasymptomatic, unless I go
cycling, when I ride a bike,when I go, when I go spinning,
or if I ride a bike, my thirdand fourth toe go numb.
It's not painful, right.
So for me it's prettyasymptomatic, only when I
aggravate it.

Jeremy (10:32):
So I was going to ask about that.
So how important is it forsomebody for, like, early
intervention or propermanagement when they get into
like, at what point should theylook at this and say this is a
problem, I should get it fixed?

Lauren Dabakaroff (10:43):
or in your case where.
Right, so like if your toes gonumb probably a sign you got a
problem right.
Yeah, it's a sign that there issomething going on.
So toe numbness is probably thenumber one sign and ball of
foot pain is also pretty high upthere with the signs and
symptoms of neuromas.
Like with, you know, I hatespinning, you know.

(11:05):
So for me I just don't spin andI don't feel my neuroma.
But I think over the years I'veprobably went away with wearing
my orthotics and I haven'treally spun lately to know if my
neuroma is still there.
So you know it's the numbnessand the ball of foot pain that's
usually the telltale sign of aneuroma.

(11:26):
You come in, I diagnose, Ievaluate treatment plan and then
it's really just about wearingthe right shoes.
I always recommend orthotics orspecial pads for the balls of
your foot that take pressure offthe nerve.
And then if, after like a fewmonths, the nerve just doesn't
get better, that's when we talkabout surgery and things like

(11:48):
that.
But just to come and see me, ifyour toes are numb and the ball
of your foot hurts witheverything, whether you're
running or you're walking, andit's just when it doesn't go
away, you definitely have tocome in and get a diagnosis for
sure.

Jeremy (12:06):
Yep can never hurt, as I learned from personal
experience.
When I came in to see I washaving pain in my foot, stopped
running for a couple of weeks,came in to see you, you fixed me
right up.
You gave me some cool insertsfor my shoes.
You recommended I get some.
What were they called?
The ankle sleeves?
Yes, and then icing the feetand I've been back running again

(12:26):
and I still have a littlediscomfort here and there, but
it's not prohibiting me fromrunning and it doesn't hurt when
I run, which is important aswell.
So thank you for that, drLauren.
I appreciate it.
You got me back on track.
Yes, kudos to you.
Yes, all right, cool, cool.
Anything else that you'd liketo leave our listeners with?
Regarding neuromas?

Lauren Dabakaroff (12:45):
For you know, just if you feel that, if you
feel like you're walking onmarbles, if you feel like
something is inside your foot,if your toes are going on when
you do activities, if you havepain in the ball of your foot,
more often than not youdefinitely have to come in and
see your local podiatrist.
And you know, get an officialdiagnosis and try to treat it,

(13:08):
because if you don't treat it itwill get worse and the neuroma
will get bigger and thensometimes it gets so big to the
point that you actually needsurgery.
You know so.
You don't want that to happen,so don't ignore it.
Pay attention to your feet,listen to what your foot is
trying to tell you and, you know, take care of them.
Wear the right shoes all thetime.

(13:29):
Shoes, you know, wear the wrongshoes.
There are like half of thereasons my patients come in to
the office because they get allthese different foot aches and
pains.

Jeremy (13:40):
Yes, speaking of shoes, it's probably time for me to get
a second pair.
I've been running with thoseBrooks now for months upon end.
I think it's good to haveanother topic for another day,
but it's good to have a varietyof shoes when you're doing a lot
of activities in them, for sure.
All right, good deal.
Dr Lauren, always a pleasureseeing you have a wonderful
weekend and I will look forwardto see you next time.

(14:02):
Everyone, thanks so much fortuning in and we will catch you
all in the next episode.
Everyone, take care.
Have a great day.
Bye.

Lauren Dabakaroff (14:09):
Bye.

Speaker 1 (14:15):
Thank you for listening to the LMD podiatry
podcast.
For more information, visit LMDpodiatrycom or call
954-680-7133.