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• Wearing larger shoes, for yoga/walking, and everyday.
• Sometimes removing the shoelaces and relacing with the lower pair of eyelets left empty can give the extra width needed.
• Sometimes ice massage helps, but there is a low success rate with nerve Yoga Injuries.
• If it continues to hurt, add metatarsal lifts to your shoe liners. These are oval-shaped pads that are placed at the front of the arch, just behind the ball of the foot in line with the middle toes. Adhesive versions are available at good shoe repair shops if your local yoga store does not carry them.
• If the problem persists, a podiatrist should construct an insert or place additions on your present footbeds during your first visit. If this approach is partially helpful but not complete, or if long-term maintenance is needed, a true medical orthotic is advised.
• A cortisone injection can be very helpful if conservative treatment doesn’t work. There is always a risk that the cortisone can weaken and shrink connective tissue. But sometimes it’s beneficial to shrink the connective tissue that surrounds the nerve and produces the thickening. It is risky to have more than about 3 injections, and mild cortisone should be used to reduce the risk of shrinking the protective fat pad under the ball of the foot. If injection is used, it should be coordinated with shoe and insert changes.
• Severe cases may require surgery in which a section of the nerve is removed. This is usually effective but is usually followed by decreased sensation in a section at the toe junction. Long-term complications are rare if the diagnosis is accurate and good surgical technique is used.
• MRI, X-ray, and ultrasound diagnosis is only slightly useful. False positives and negatives are common.
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• Treatments such as acupuncture, foot manipulation, sclerosing injections, and traditional physical therapy may help and are worth considering, but the percentage of success is lower. These are usually recommended if surgery appears to be the only alternative.
• Often it is a “teamwork” of several treatments at the same time that starts the healing process when one singular approach has failed.
• The goal of treatment is to eliminate pain.
• A permanent change of shoe styles and wearing special orthotics can help in reducing pressure on the foot. When this happens, the nerve will probably shrink and remodel itself to its original condition. This process takes many months but can result in fewer shoe restrictions and sometimes the cessation of orthotics.
• Some people, especially those who have had problems in non-sport shoes, or those who had pain for several months to years, may always be sensitive to return of any pain.
• When proper orthotics are used, the pain should improve very quickly. Some feeling of relief is immediate, but over a period of a couple of days further progress is possible. If they are fabricated improperly, the symptoms can even get worse.
• If an injection is required and is performed correctly, there should be a few hours of very strong relief as the local anesthetic that is mixed with the cortisone kills the pain. This can be helpful for confirming the diagnosis. If very little relief occurs, it may mean that another condition is causing the pain.
• It commonly takes several days for an injection to work. Do not assume failure for at least 2 weeks. The foot may be more sore for a couple of days.
• Pain is an indication of further damage and continued growth of the neuroma. One or two runs with moderate soreness is OK, but no one should continue to train hoping the pain will go away on its own.
• Often the pain is so strong it is impossible to yoga or walk, or when yoga causes a harmful compensation. In this case the foot stays tense or rotates through an unnatural range of motion leading to secondary Yoga Injuries in the knees, hips, ankles, etc.