Nerve Problems & Types of Disorders

Nerve Problems (Pathology)

There are a multitude of potential nerve problems that can be encountered in the foot and ankle. They can range from neuropathy caused by diabetes, or chemotherapy, to nerve entrapment secondary to rapid weight loss. There are also more simplistic issues such as the classical “Morton’s neuroma”. Regardless of the type of nerve pain experienced – there are new innovative treatments offered. The most important part of treating nerve pain is accurate and timely diagnosis.

Doctor Adams is a Fellowship Trained Foot and Ankle Surgeon who has done specialty training in nerve surgery. Dr. Adams has given presentations, and has been involved in research regarding peripheral nerve entrapment, and pain. It is important to understand that there is more treatment available for nerve pain than taking oral medicines.

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If you have suspected nerve pain and have questions or concerns, please feel free to call Doctor Adams at (317) 477-6683, or schedule a consultation online.

Learn more about Dr. Adams

Dr. Adams is a born and raised Hoosier. He attended Indiana University-Bloomington where he met his wife Allison. He got degrees in Nutrition Science, Biology and Chemistry. Dr. Adams then got his doctorate from Kent State College of Podiatric Medicine where he was a Dean’s List student. He then came back to Indianapolis to do his residency surgical training and was Chief resident. He stayed in Indianapolis and completed a specialty Fellowship focusing on Adult and Pediatric Reconstruction. During his Fellowship Dr. Adams helped launch the first foot and ankle dedicated surgical practice at Hancock Orthopedics, and has been employed there since.

Dr. Adams enjoys teaching as he helps educate and train the surgical residents at Community Health Network, and the Fellows at American Health Network. He actively participates in research and editing for national peer reviewed journals.

He is also a consultant for orthopedic device companies where he is afforded the opportunity to help train and design with other surgeons across the country.

Dr. Adams has special interests in the following areas:

Arthroscopic joint surgery

Minimally invasive calcaneal fracture repair

Flat foot reconstruction, adult and pediatric

Vitamin D and its correlation with bone healing

Cartilage restoration for the ankle joint

Regenerative medicine

5th Metatarsal fractures

Non-union revision surgery

Dr. Adams is a father of two and resides with his family in Fishers. He enjoys the short commute to Hancock Health in Greenfield.

William J.E. Adams, DPM CV (pdf)

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Morton’s Neuroma

Named after Dr. Morton whom it was first described by. This is a condition that occurs when there is chronic nerve entrapment of a digital nerve at classically the 3rd interspace in the foot (between toes 3 and 4). The chronic irritation to the nerve causes it to become enlarged (perineural fibrosis) – this enlargement of the nerve is then what is known as a neuroma. This neuroma development can occur in any interval between the metatarsals or innerspace. But most frequently is seen at the 3rd.

Conditions that can predispose people to this are cavus feet, improperly fitting shoes, and certain activities that cause you to overly load the outside aspect of your foot during weight bearing activity.

Patient’s describe Morton’s neuromas as having the sensation of bunched up sock, or a pebble underneath the base of their toes. They can cause stabbing, sharp pain near the bottom of the toes.

They often respond to coservative care such as steroid injections, topical pain creams, shoe inserts, changing shoe gear, and anti-inflammatories. Some doctors use alcohol sclerosing injections but more recently this therapy has lost favor, and is often not recommended any longer.
(https://pubmed.ncbi.nlm.nih.gov/21733418/)

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Before & After Photos of Nerve Problems

*Your results will vary

June 3, 2021bywil-adams-dpm

November 27, 2020bywil-adams-dpm

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Peripheral Neuropathy

There is too much on this topic to truly elaborate properly on all aspects of this condition. There are extremely diverse causes of peripheral (in the extremities) neuropathy (nerve disease); and a multitude of them. Generally the more common causes we see in the average person are diabetes, exposure to toxins, drugs/medications, cancer therapy, neurologic disease such as Charcot Marie Tooth, and even old age! It is a common condition in the general population. Even though it manifests as numbness to some degree, patients can still have pain and paresthesias concomitantly.

In diabetic patients a well documented cause of neuropathy can actually be the medication Metformin, which is an oral medicine used to treat hyperglycemia/elevated blood sugars. This is something that can be treated with Vitamin B replacement therapies. Diabetes itself of course is the most common cause of peripheral neuropathy in the US, but unfortunately a medication used to treat diabetes can also exacerbate the condition.

Are you an Indianapolis resident seeking a foot & ankle surgeon?

Dr. Wil Adams is close and worth the short drive.

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Tarsal Tunnel Syndrome

A condition that occurs when the nerve (posterior tibial) on the inside of the ankle becomes entrapped, pinched, crowded, or compressed causing unpleasant symptoms in the plantar foot.

Tapping on the nerve can elicit what’s known by doctors as a “positive tinel’s sign”. This is partially diagnostic even though it does not seem very scientific.

EMG/NCV is a test that is sometimes ordered to further evaluate for nerve entrapment and damage. The test can be uncomfortable but when done properly should be tolerable. It does involve using needles to stimulate muscle groups. Oral sedation can be used if needed. It is a very helpful test in many instances. Note: EMG/NCV’s is a test that is somewhat operator dependent – it is an art. An EMG/NCV performed by one doctor may vary in results compared to a different doctor. Sometimes a 2nd opinion is helpful.

Diagnostic ultrasound guided steroid blocks can be very helpful in differentiating nerve entrapment from another issue such as tendonitis for example.

Topical pain creams, US guided steroid injections, shoe inserts, oral medications such as steroids, neuro modulation drugs, NSAIDs, and lastly surgical release of the nerve (neurolysis) is generally needed when the condition fails to respond to conservative measures.

It varies – but typically once the skin heals in 2-3 weeks patients are allowed to go back to activities as tolerated. Patients are permitted to walk immediately after surgery but no lower extremity exercise is allowed.

No – when patients truly have tarsal tunnel syndrome sometimes immediate relief is achieved following surgery. There is always soreness associated with surgery, but this is well controlled with NSAIDs and painkillers.

Yes (unless A1C is very high – &/or clearance from PCP is not achieved due to various health concerns) – in fact oftentimes diabetes causes peripheral nerves to swell as a result of chronic hyperglycemia, or elevated blood sugars. This surgery can be very helpful to alleviate symptoms.

Patients often describe it as “a blowtorch on the bottom of my foot”. “My arch and toes burn everyday”. “I have aching at the inside of my ankle that intermittently causes shooting, or stabbing pains”. Nerve pain does not necessarily correlate with activity levels.

Charcot Marie Tooth

Charcot Marie Tooth or also known as CMT for short is a progressive neurologic disorder that affects the lower extremities in those afflicted by it.

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Drop Foot

Drop foot/Foot drop, or “foot slap” is a condition where the muscles that reside on the front of the shin bone (tibia) are not functioning properly. When those muscles are overly weak due to neurologic disease, nerve entrapment, trauma, etc, this causes the suffering individual to not be able to lift their toes up during the swing phase of gait. It also causes the individual to not have the ability to smoothly place the foot back on the ground during the contact phase of gait causing the audible “foot slap” that is classically noted.

The condition can be very debilitating due to it causing individuals to walk with an unusual (steppage) gait to avoid catching their toes, and tripping themselves during daily activities.

The issue can be addressed both conservatively with bracing,and surgically with a variety of options depending on the conditions etiology (cause).

Nerve Entrapment (Pinched Nerve)

This nerve becomes superficial and peeks out at the outside of the calf muscle about half way down the leg, and turns into 2 nerves typically at the level of the ankle joint. This nerve can become entrapped due to a variety of reasons. It can be pinched in work boots, or injured from surgeries ( such as ankle arthroscopy), and trauma at the outside of the lower leg.

This nerve becomes superficial just above the level of the ankle joint. It can get compressed or entrapped at the front of the ankle, and on the top of the foot. Poor fitting shoes, cavus feet, trauma, and midfoot arthritis are things that can cause irritation to this nerve.

This nerve runs down the front of the leg, just on the inside aspect of the calf muscle. It is less commonly entrapped as compared to the SPN, DP, or Sural nerves. When it is entrapped it will cause paresthesias (numbness, burning, tingling, radiating pain) at the inside of the shin bone and down towards the front inside of the ankle and potentially onto the foot.

The sural nerve is notorious for entrapment and generally being more sensitive to compression and irritation from surgical procedures. It runs along the back of the calf, along the interval between the fibula and achilles tendon, and along the outside of the foot and terminates at the 5th (pinky) toe. It truly can become entrapped anywhere along its course. This is somewhat due to its very superficial nature – especially in very skinny individuals.