Burning, Tingling, or Numbness in Your Feet?
“You may not have the neuropathy you’ve been told you have.”
Advanced, Non-Surgical Treatment for Foot Neuropathy and Nerve Pain — Serving Marble Falls and Highland Lakes.
You know the feeling. The burning that wakes you up at two in the morning. Pins and needles that won’t quit. Socks feeling like sandpaper. Bedsheets stinging where they touch your skin. Maybe a doctor has told you it’s “just neuropathy.” Maybe nobody’s told you anything definitive at all. Either way, you’ve been left without real answers — and without real options.
For many of the patients we see, the standard explanation turns out to be incomplete. We routinely find specific, treatable causes hiding behind the neuropathy diagnosis — focal nerve entrapments, Morton’s neuroma, even pinched nerves in the lower back — that respond well to conservative care.
You don’t have to live with it. And for most patients, the path forward is conservative — once we know what we’re actually treating.
Book Your Evaluationor call (830) 265-6000 to speak with our team directly.
Most major insurance plans accepted.
Dr. Henry on Neuropathy
What Patients Are Saying
Real outcomes from patients who came to us after being told their symptoms were untreatable.
“My neurologist ran the nerve test, said it was peripheral neuropathy, and told me there wasn’t much to do besides the medication. The medication made me foggy and didn’t really help. Dr. Henry put tape on my foot at the first visit and within a day the burning was noticeably better. Turned out to be tarsal tunnel — something the test had missed. Custom orthotics and laser therapy later, I’m walking the lake path again.”
“For two years a neurologist told me the burning in the ball of my foot was ‘small fiber neuropathy’ and put me on gabapentin. Dr. Henry did an ultrasound at my first visit and showed me the Morton’s neuroma on the screen. Custom orthotics and laser therapy — I’m off the medication and walking again.”
“A surgeon in Austin told me I needed a nerve release operation in both feet. I came to Dr. Henry for a second opinion before scheduling. He found the diagnosis was right but the treatment was wrong — orthotics, taping, and a structured conservative program over a few months gave me my feet back without anyone cutting on me. I would have agreed to surgery I didn’t need.”
What Most Patients Diagnosed With Neuropathy Are Never Told
Peripheral neuropathy is a real condition. Many patients have it. But “neuropathy” has also become a catch-all label — applied broadly, sometimes accurately, often not. When a patient comes to us with burning, tingling, or numbness in the feet, the first question we ask isn’t how do we treat your neuropathy. It’s do you actually have what you’ve been told you have. The answer, more often than people realize, is no — or only partly. Three specific causes get missed again and again, and each one responds to treatment.
Tarsal Tunnel Syndrome — The Carpal Tunnel of the Foot
The posterior tibial nerve runs through a narrow tunnel on the inside of the ankle, just like the median nerve runs through the carpal tunnel at the wrist. When that tunnel gets crowded — by overpronation, by a thickened tendon, by a small mass, by anatomic variation — the nerve gets compressed, and the patient feels burning, tingling, and numbness in the sole and toes. The symptoms mimic peripheral neuropathy almost exactly.
Here’s what makes tarsal tunnel different from carpal tunnel: most of the time it doesn’t need surgery. It responds to custom orthotics, laser therapy, and biomechanical correction — when somebody actually identifies it. The problem is that most workups don’t. Standard nerve conduction tests miss tarsal tunnel syndrome roughly twenty to forty percent of the time, and a normal test gets read as evidence the patient has “small fiber neuropathy” instead. The tunnel is the actual problem. The test just couldn’t see it.
Morton’s Neuroma and Other Forefoot Nerve Entrapments
The interdigital nerves between the long bones of the foot can swell and become irritated, producing burning pain, numbness, or the sensation of “walking on a stone” in the ball of the foot. Morton’s neuroma is the most common version. There are others — peripheral entrapments of small sensory branches that produce localized symptoms patients (and many providers) interpret as part of a generalized neuropathy.
These conditions are rarely diagnosed by nerve conduction testing — the nerves are too small and too distal for the technique to reliably detect them. They are, however, readily seen on diagnostic ultrasound, often in real time during the first visit. Once identified, the first line of treatment combines custom orthotics with laser therapy. For more resistant cases, perineural injections are the next step. Surgery is rarely necessary, but in the small number of cases that don’t respond to comprehensive conservative care, it remains an option.
Lumbar Radiculopathy — The Pinched Nerve You Don’t Feel In Your Back
This is the one most patients never see coming. A nerve root pinched in the lower spine — by a disc, by arthritis, by stenosis — can produce burning, tingling, or numbness in the foot without producing pain in the buttock, thigh, or leg. The nerve gets irritated, and the symptoms it carries appear at its destination, not along its path.
The result is a patient with foot symptoms, no back pain, and a primary care provider who doesn’t think to look at the spine because nothing else hurts. The patient gets a neuropathy label and is sent home with medication. Meanwhile, the actual problem is two segments above the hip. A careful clinical evaluation can usually distinguish radiculopathy from peripheral nerve compression, and when the back is the source, even the foot symptoms often respond to treatments aimed at the lumbar spine — including, in selected patients, properly fabricated orthotics that modify how forces transmit up the kinetic chain.
Each of these three conditions sits inside the broader “neuropathy” label, and each gets missed in the same way: by a workup that wasn’t designed to find it. You walk out of the office with a prescription, a label, and the unspoken message that this is just how it’s going to be.
But it wasn’t true: you don’t have to live with it.
Why a Normal Nerve Test Doesn’t Mean You’re Out of Options
The most common scenario we see goes like this: a patient develops burning or numbness in the feet, gets referred to a neurologist, has a nerve conduction study done, and is told either “you have peripheral neuropathy” or “the test was normal — must be small fiber neuropathy — try gabapentin.” In neither case did anyone evaluate whether the symptoms might be coming from a focal entrapment, a forefoot neuroma, or the lower spine. That’s not a failure of the neurologist. It’s a limitation of the workup itself.
What Nerve Conduction Studies Are Good At
Nerve conduction studies measure how electrical signals travel along peripheral nerves. They’re useful — they confirm generalized peripheral neuropathy, document its severity, and rule out certain motor disorders. For diffuse, large-fiber neuropathy, the test does what it’s designed to do.
What They Miss
Where the test falls short is precisely where most of our patients turn out to need help. Published clinical literature reports that standard nerve conduction studies miss tarsal tunnel syndrome in twenty to forty percent of cases — sometimes more — and the specificity is poor enough that the American College of Foot and Ankle Surgeons has formally cautioned against using these tests alone to rule it in or out. Morton’s neuroma and small forefoot nerve entrapments are even harder to detect electrically, because the relevant nerves are too small and too distal for reliable surface measurement. And lumbar radiculopathy presenting only as foot symptoms, with a healthy-looking back, isn’t something a foot-and-ankle nerve test was ever designed to find.
A normal nerve conduction study tells you what isn’t broken at the level the test can see. It doesn’t tell you what’s actually causing your symptoms.
What We Add to the Workup
When you come in for a first visit, the evaluation looks different from what you’ve had before. It includes a full clinical history that asks specifically about the back, about footwear, about activity patterns, about prior tests. It includes a focused biomechanical examination of the foot and ankle. It includes in-office digital weight-bearing X-rays reviewed with you on the screen — and these tell us a great deal. Lateral weight-bearing views in particular show us how the arch is loading under your body weight, where the structure is collapsing, and how that collapse is contributing to the nerve compression patterns we look for in tarsal tunnel syndrome and Morton’s neuroma. And in most cases the evaluation includes diagnostic ultrasound of the tarsal tunnel and forefoot, which lets us actually see the structures the nerve test can’t measure.
It also includes one diagnostic step that’s central to how we sort out what’s going on, and it’s simpler than anything else on the list.
The Orthopedic Tape Test
At the end of the first visit, in most cases, we apply a specific pattern of orthopedic taping to the foot and ankle. The tape modifies how forces transmit through the foot — supporting the arch, offloading specific structures, reducing strain on entrapped nerves. You leave the office wearing it. Over the next twenty-four to forty-eight hours, you tell us whether your symptoms changed.
If the tape produces meaningful relief, that’s diagnostic information we couldn’t have gotten any other way. It tells us your symptoms have a mechanical component — and mechanical contributions respond to mechanical solutions. Custom orthotics, biomechanical correction, and the conservative protocols we’ve already described tend to work for these patients.
If the tape produces little or no relief, that’s also useful information. It points us toward causes the tape can’t influence — true diffuse peripheral neuropathy, certain types of nerve damage that have moved past the mechanical stage, or systemic contributors that need a different approach. Different track, different treatments, but still real options.
The tape test is short-lived and diagnostic by design. It’s not a treatment, and any relief it produces won’t last. What it gives us is the information that helps us put you in the right treatment program from the start, instead of trying things at random for months and seeing what sticks.
Three Treatment Paths — Which One Is Right for You?
Between the history, the X-rays, the ultrasound, and the response to orthopedic taping over the days following the first visit, we usually have a clear sense of which of three treatment tracks fits your situation. Most patients fall into the first one. Some fall into the second. A small number — and it really is a small number — fall into the third. Each track is designed for a specific clinical picture, and each one has worked for the patients it was meant for.
Card 1 — The Mechanical Track
For patients whose symptoms have a treatable mechanical cause.
This is where most patients end up. If the tape test produced meaningful relief, if the X-rays showed arch collapse contributing to the symptom pattern, or if diagnostic ultrasound identified a focal entrapment or neuroma, your symptoms have a mechanical component — and mechanical contributions respond to mechanical solutions.
Treatment in this track typically combines high-quality custom orthotics designed specifically for your foot structure, laser therapy to reduce nerve inflammation and support nerve healing, and biomechanical correction to address how forces transmit through the foot during daily activity. For more resistant cases or specific findings like Morton’s neuroma, perineural injections add a targeted second line.
Most patients in this track see meaningful improvement within the first few weeks. Custom orthotics last fifteen to twenty years with periodic adjustments — a real medical device, not a comfort product, and not something you’ll need to replace every season.
Card 2 — The Comprehensive Neuropathy Program
For patients with true diffuse peripheral neuropathy.
For patients whose tape test produces little or no relief, whose findings point toward a generalized neuropathy rather than a focal cause, we offer a structured multi-week program built around three components.
The first is FDA-cleared electromedical therapy using a high-frequency electronic signal designed to support nerve cell function. The second is a series of targeted perineural anesthetic blocks performed during the early treatment sessions, which reduces nerve irritability and improves how the nerves respond to the electromedical signal. The third is supportive orthotic therapy where biomechanical findings warrant it — even patients with diagnosed neuropathy often have mechanical contributors that, when addressed, reduce overall symptom load.
This is a real commitment. The program runs for approximately two to three months with sessions one to two times per week, and we’re honest about that up front. We’re equally honest about expectations: this is not a guarantee of cure, and individual results vary. What it offers is a structured, evidence-supported path forward for patients who have been told there’s nothing more to do — when in fact there often is.
Card 3 — Surgical Referral When Appropriate
For the rare patient where conservative care has failed and clinical findings suggest a specifically treatable nerve compression.
Surgery is rarely the right answer for foot nerve symptoms. But for a small number of patients — those who have completed appropriate conservative care without adequate response, and whose clinical findings point clearly to a compressed nerve at a known anatomic site — surgical decompression by a qualified specialist can be the right next step.
When we identify a patient in this category, we refer to a surgeon trained specifically in peripheral nerve decompression. We don’t perform these procedures ourselves, and we don’t refer lightly. The bar for moving from conservative care to surgical referral is high, and the conversation about whether you’ve actually reached it is one we have together, with all the information from your evaluation in front of us.
Most patients never need this track. The few who do are glad we have it.
About Dr. Frank J. Henry, DPM, FACFAS
Dr. Frank J. Henry is a board-certified foot and ankle surgeon with more than thirty years in practice — the past eight serving the Highland Lakes and Hill Country communities, after a long-established practice in South Texas. Across his career he has cared for more than forty thousand patients, and he keeps approximately ninety-five percent of them out of the operating room. His practice philosophy is built on a simple principle: most foot and ankle problems are biomechanical, and most biomechanical problems respond to the right combination of conservative treatments — when somebody takes the time to identify what’s actually wrong. Dr. Henry trained as a surgeon and refers for surgery when surgery is genuinely the right answer. The rest of the time, he treats the cause.
“In thirty-plus years treating foot and nerve conditions, I’ve seen too many patients given up on too quickly. Many of the people who come to me with a ‘neuropathy’ diagnosis discover their symptoms have a treatable cause that nobody had looked for. The first job is to figure out what’s actually wrong. Then we talk about what to do about it.”
— Dr. Frank J. Henry, DPM, FACFAS
What to Expect at Your First Visit
The first visit takes about an hour. By the end of it, you’ll know what’s actually causing your symptoms — or you’ll know the next step in finding out. We don’t send you home with a label and a prescription. We send you home with information you can act on.
Most patients leave the first visit with more clarity about their condition than they’ve had in months — sometimes years. That’s the point of the visit, and it’s the point of how we practice.
or call (830) 265-6000 to speak with our team directly.
Frequently Asked Questions
Honest answers to the questions patients most often bring to the first visit.
I’ve already been told I have neuropathy. Why come to you?
Because “neuropathy” is a label, not a diagnosis. It tells you a category of symptoms — burning, numbness, tingling — but it doesn’t tell you what’s causing them, and the cause is what determines whether your symptoms are treatable. Many patients who arrive with a neuropathy diagnosis turn out to have a focal nerve entrapment, a Morton’s neuroma, a contribution from the lower spine, or a mechanical component that nobody had identified. We use diagnostic tools — weight-bearing X-rays, in-office ultrasound, orthopedic taping, careful clinical history — that aren’t part of a standard neurology workup. The point of the first visit is to find out what you actually have, so the treatment can match the cause.
Can a problem in my back really cause numbness in my feet without my back hurting?
Yes — and it happens more often than most patients realize. A nerve root can be compressed in the lower spine and produce burning, tingling, or numbness in the foot without producing pain in the back, the buttock, the thigh, or the leg. The irritated nerve carries the symptoms to its destination, not along its path. This is one of the reasons we ask carefully about back history during the first visit, even when patients tell us their back feels fine. When the spine is contributing, even the foot symptoms often respond — sometimes to treatments aimed at the back, and in selected cases to properly fabricated orthotics that change how forces transmit up the kinetic chain.
My nerve conduction test was normal but my feet still burn. What’s happening?
A normal nerve conduction study tells you the test didn’t detect a generalized large-fiber neuropathy. It doesn’t tell you what’s actually causing your symptoms. Standard nerve conduction testing misses tarsal tunnel syndrome twenty to forty percent of the time, isn’t a useful test for Morton’s neuroma or small forefoot entrapments at all, and was never designed to detect lumbar radiculopathy presenting only as foot symptoms. A normal test is meaningful, but it’s not the end of the diagnostic conversation. It’s often the beginning.
What’s the orthopedic tape test, and what does it tell you?
It’s a specific pattern of taping we apply to your foot and ankle at the first visit. The tape modifies how forces transmit through the foot — supporting the arch, offloading specific structures, reducing strain on entrapped nerves. You wear it home and tell us over the next twenty-four to forty-eight hours whether your symptoms changed. If the tape produces meaningful relief, your symptoms have a mechanical component, and mechanical contributions respond to mechanical solutions like custom orthotics. If the tape produces little or no relief, that’s also useful — it points us toward causes the tape can’t influence, and a different treatment track. The tape itself is short-lived and diagnostic by design. The information it gives us is what makes it valuable.
Do I need to commit to a long treatment program?
Most patients don’t. The largest group — those whose symptoms have an identifiable mechanical cause — see meaningful improvement within the first few weeks of treatment with custom orthotics, laser therapy, and biomechanical correction. The longer structured program is reserved for patients with true diffuse peripheral neuropathy where a multi-month protocol with electromedical therapy and perineural blocks offers a structured path forward. The decision about which path fits your situation is made together at your follow-up visit, after we’ve reviewed the results of the tape trial and any imaging findings. Nobody is committed to a long program before we know whether they need one.
What if I do need surgery? Do you do it?
We don’t perform peripheral nerve decompression surgery. For the small number of patients where conservative care has been thoroughly attempted without adequate response, and where clinical findings clearly point to a treatable nerve compression, we refer to a qualified specialist trained specifically in this work. Most patients never need this referral. The few who do are well-served by being sent to someone who does this kind of surgery often, rather than to someone who does it occasionally.
Are diabetic patients candidates for the same treatments?
Yes — and often, the diagnostic reframe matters even more for diabetic patients. The medical literature has increasingly recognized that diabetic neuropathy frequently has a mechanical component superimposed on the metabolic one. Identifying and treating the mechanical contribution can meaningfully reduce symptoms even when the underlying diabetic neuropathy persists. Our diagnostic approach — weight-bearing X-rays, ultrasound, taping, careful clinical history — applies equally to diabetic patients, and many find that their “diabetic neuropathy” symptoms responded to treatments their previous workup never offered.
Get a Real Diagnostic Workup
You’ve been told to live with it. You’ve been handed a prescription and sent home. You’ve been bounced between specialists who didn’t talk to each other. You don’t have to keep doing that. Find out what’s actually causing your symptoms — and what your real options are.
Book Your Evaluationor call (830) 265-6000 to speak with our team directly.
