Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Neuroma pain and misdiagnosis

Posted by DR. Kosova on 1/22/01 at 01:25 (037056)

I have had 4-5 patients in the last year that were sent to me for second opinions that were tx unsucessfully for neuromas. They were all set to have sx. When I examined them most had pain in the web spaces 2 or 3 but no other symptoms or signs. I sent them for mri and ALL had precortical bone pathology. Mris have a fat supression technique that can detect bone insult early then they used to. treatment plans were anywhere from wearing a surgical shoe for a couple weeks to cast with crutches. All got better with no signs of neuroma on Mri which can happen anyway.Again they were all set for sx.

anyone with similar findings??
thanks

Dr. Kosova

Re: Neuroma pain and misdiagnosis

Barbara TX on 1/22/01 at 02:34 (037062)

Hello doctors... can MRI's show neuromas? I had a recent MRI and it was clear (except for a thickening of the pr and spurs), but I have typical neuroma pain. Do some show up and some not? I am talking about an inter-metatarsal neuroma, not one in the heel. My neuroma pain seemed to come and go over the course of a month, and then came to stay permanently over the course of a few days. Is this typical? B.

P.S. This is one of the unfortunate things about PF... it really does play havoc with the rest of your foot if the PF doesn't resolve soon enough. Your body makes almost inperceptible gait shifts that distribute weight to places that aren't designed to bear it. I think that might have occured with me... :-(

Re: Neuroma pain and misdiagnosis

cindyp on 1/22/01 at 08:42 (037069)

To answer your question yes they can. They shot both of my feet for comparison and you can see mine plain as day. 1/2' in cirucmference in my heel.

Re: Neuroma pain and misdiagnosis

Dr. Zuckerman on 1/22/01 at 21:16 (037120)

I recently ordered an mri for an evaluation of a neuroma and to rule out any boney pathology. The center used a contrast dye with the mri study should enough the neuroma mass very clearly seen. In most cases I am looking for any bone pathology and not for neuroma. In my opinion the physical examination is the most important way for a diagosis .

Dr. K makes a very important comment regarding the pre-cortical changes that can be seen with the mri.

I

Re: Neuroma pain and misdiagnosis

Dr. Marlene Reid on 1/24/01 at 11:36 (037210)

Hi Barbara,

I have found with the early stages of what I think is a neuroma in patients that they often come up negative on MRI which sometimes isn't as specific or detailed as we want. The MRI report depends on a lot of things: the radiologist's skill in reading (few have alot of experience in reading the foot), the MRI itself (they say that the open MRI is not quite as good), if both feet are done together, and if there was any patient movement.

Sometimes you can pick up a neuroma on a diagnostic ultrasound. But if I am really convinced it is a neuroma and the MRI is negative, I still treat it as if its a neuroma.

I have also found early neuroma pain to be a little more vague and not apparent every day. usually it is worse in higher heels, but not always. I had two recent patients that have told me they felt better in heels. I think the reason for this may be that the neuroma is a little more distal (further towards the toes).

And yes PF DOES cause all types of other problems indirectly.

Re: Neuroma pain and misdiagnosis

Barbara TX on 1/22/01 at 02:34 (037062)

Hello doctors... can MRI's show neuromas? I had a recent MRI and it was clear (except for a thickening of the pr and spurs), but I have typical neuroma pain. Do some show up and some not? I am talking about an inter-metatarsal neuroma, not one in the heel. My neuroma pain seemed to come and go over the course of a month, and then came to stay permanently over the course of a few days. Is this typical? B.

P.S. This is one of the unfortunate things about PF... it really does play havoc with the rest of your foot if the PF doesn't resolve soon enough. Your body makes almost inperceptible gait shifts that distribute weight to places that aren't designed to bear it. I think that might have occured with me... :-(

Re: Neuroma pain and misdiagnosis

cindyp on 1/22/01 at 08:42 (037069)

To answer your question yes they can. They shot both of my feet for comparison and you can see mine plain as day. 1/2' in cirucmference in my heel.

Re: Neuroma pain and misdiagnosis

Dr. Zuckerman on 1/22/01 at 21:16 (037120)

I recently ordered an mri for an evaluation of a neuroma and to rule out any boney pathology. The center used a contrast dye with the mri study should enough the neuroma mass very clearly seen. In most cases I am looking for any bone pathology and not for neuroma. In my opinion the physical examination is the most important way for a diagosis .

Dr. K makes a very important comment regarding the pre-cortical changes that can be seen with the mri.

I

Re: Neuroma pain and misdiagnosis

Dr. Marlene Reid on 1/24/01 at 11:36 (037210)

Hi Barbara,

I have found with the early stages of what I think is a neuroma in patients that they often come up negative on MRI which sometimes isn't as specific or detailed as we want. The MRI report depends on a lot of things: the radiologist's skill in reading (few have alot of experience in reading the foot), the MRI itself (they say that the open MRI is not quite as good), if both feet are done together, and if there was any patient movement.

Sometimes you can pick up a neuroma on a diagnostic ultrasound. But if I am really convinced it is a neuroma and the MRI is negative, I still treat it as if its a neuroma.

I have also found early neuroma pain to be a little more vague and not apparent every day. usually it is worse in higher heels, but not always. I had two recent patients that have told me they felt better in heels. I think the reason for this may be that the neuroma is a little more distal (further towards the toes).

And yes PF DOES cause all types of other problems indirectly.