DEAR DR. DONOHUE: My husband and I walk daily for quite long distances, five or more miles. We also walk fast. I have developed a pain on the bottom and front of my left foot. It feels like I have a rock in my shoe. My husband says it’s a Morton’s neuroma.

He made this diagnosis based on his past experiences. Do you think he might be correct? If he is, what do I do for it? Is an X-ray necessary? — L.P.

ANSWER: Your description of your foot pain puts Morton’s neuroma as a leading contender for its cause. It’s an enlargement of a foot nerve and the tissues that surround the nerve. The pain arises about 1 inch or so down from where the toes join the foot. The most common place is the area that corresponds to the space between the third and fourth toes. Firm thumb pressure on that area triggers pain. Try it.

X-rays aren’t needed. A doctor will order X-rays if the chances of other conditions exist, things like a stress fracture of the foot bones.

Banging the feet against the ground is the reason why neuromas form. Adding to that are high-heel shoes. They put a great deal of pressure on the sole at the front of the foot. Furthermore, they have restricted space for the toes, and that increases pressure in the area.

Take a break from walking. Get shoes that absorb the shock of the foot striking the ground. Make sure there is ample space in the front of the shoe to accommodate the toes comfortably. Pad the painful area or wear a padded insole in your shoes.

If things haven’t turned around for you within two weeks, see a doctor. The doctor can confirm the diagnosis and might inject the area with some cortisone. That often brings quick relief.

DEAR DR. DONOHUE: Does muscle size determine a person’s strength? I have a friend who says no. He says that bodybuilders with gigantic muscles are not able to lift the amount of weight that powerlifters lift. They have big muscles too, but not as big as those of bodybuilders.

I want to build big muscles. What’s the best way of going about that? Does the time of day matter? — L.B.

ANSWER: Muscle size is one factor that figures into a person’s strength, but it’s not the only factor. Strength depends on the number of muscle fibers incorporated into whatever the activity might be — lifting, pushing or pulling. Training makes the brain enlist more muscle fibers than would be recruited without that training. Training with very large loads is necessary for power lifting success. Muscles can be built without such huge loads.

Power lifting also requires a different lifting technique than does muscle building.

Nutrition is important for both. Muscle builders try to have a protein meal within two hours of exercise. That is the time interval in which protein in food is best incorporated into building muscle size.

The time of day isn’t of great importance in muscle building. In the late afternoon and early evening, body temperature is slightly higher than it is at other times. The increase in body temperature enhances muscle performance, but not tremendously. Exercise at a time that’s convenient for you.

DEAR DR. DONOHUE: Can you give me an idea of the number of calories burned while swimming hard? — F.H.

ANSWER: Calorie burning, regardless of the activity, has to take into account body size. For swimming, the stroke used is another consideration.

However, vigorous swimming for one full hour can burn as many as 700 calories.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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