It is quite common for people with the diagnosis of a neuroma, or nerve entrapment, to undergo multiple surgeries attempting to alleviate the entrapment. One individual came to us at Caring Medical with a history of 15 surgeries! This occurs primarily because most physicians incorrectly believe numbness is equated with a pinched nerve. Ligaments and tendon weakness in the limb also cause chronic numbness in an extremity.

Despite years of experimental research and clinical investigation, the painful neuroma has remained difficult to prevent or to treat successfully when it occurs. More than 150 physical and chemical methods for treating neuromas have been utilized including suturing, covering with silicone caps, injecting muscle or bone with chemicals such as alcohol, and many others.

Surgical treatment has been problematic with poor results and complications. In one study, 47 percent of the patients continued to have symptoms of foot pain after surgery. The reason for continued symptoms after surgery or chemical injections may be that the chronic foot pain or numbness is due to ligament weakness and not a pinched nerve.

Tarsal Tunnel Syndrome
Another diagnosis used for chronic burning foot and/or toe pain is Tarsal Tunnel Syndrome. Tarsal Tunnel Syndrome is very similar to Carpal Tunnel Syndrome of the hand except it involves the foot. The tibial nerve runs in a canal on the inside of the foot called the tarsal tunnel. When the tibial nerve gets pinched here, it is called Tarsal Tunnel Syndrome. The symptoms described for this syndrome include pain in the ankle, arch, toes, or heel.

Chronic burning arch, toe, or heel pain is most often due to ligament weakness at the ball of the foot or soft tissue weakness in the arch of the foot, rather than pinching of a nerve as in Tarsal Tunnel Syndrome. The ball of the foot is called the metatarsal joints and supports half the body weight during walking.

Since these structures bear the bulk of the body weight when a person stands, walks, or runs, it is no wonder that these are generally the first structures to weaken. Metatarsal ligament weakness is manifested by pain at the ball of the feet which often radiates into the toes. This is called metatarsalgia. 

A weakened arch causes the foot to feel weak and tired especially after a day of standing or walking. It can also radiate pain into the big toe side of the foot. Chronic metatarsal ligament weakness and arch weakness (also known as plantar fascutis). Fasciitis can cause numbness in the foot and toes in the same areas of pain. Pain and numbness in the foot can also be caused by ligament and tendon laxity in the knee. The lateral collateral ligament can refer pain and numbness down the lateral side of the leg and foot and the medial collateral ligament down the medial side. Thus anyone with foot pain or numbness needs to have their knees looked at to see if there is any evidence of ligament weakness there.
 

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