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mortons neuroma

Posted by Joan A on 6/02/02 at 13:05 (086083)

I have Morton's neuroma in my left foot that is so painful. I wear orthotics but is only helpful for a short period. We like to dance so I purchased open sandals with a heel about 1 1/2' hoping I would be alright.I can dance for about an hour and then the pain gets so bad I can't stand it. Even sitting with the preasure on the ball of my foot get's too much, so I end up sitting with my shoe off watching everyone else dance. I'm seriously thinking of surgery but have heard a lot of negative comments. Wondering if there has been success here?

Re: mortons neuroma

Nancy M on 6/02/02 at 16:19 (086100)

Hi Joan,

I've had 3 neuromas removed. First time in my left foot between 3rd and 4th toe in June 1998. The other 2 at the same time - in left foot between 2nd and 3rd toe and in the right foot between the 2nd and 3rd toe in July 1999. I've had no problems from the surgeries until a month ago. I was told that they can come back and unfortunately it has in my left foot. Went to the doctor last Tuesday and received a shot, hasn't worked. Back to the doctor on June 11th probably for another shot. With the way my luck is with my feet I'll probably end up having surgery again. My doctor did tell me he also felt scar tissue in there. I can be standing or sitting with my feet up or down and just feel a burning wad in the ball of my foot.

Nancy M in AZ

Re: mortons neuroma

DR Zuckerman on 6/02/02 at 16:25 (086101)

Hi

Try having alcohol injections done. This is very effective had a very high rate of sucess and avoidance of neuroma foot surgery.

Re: mortons neuroma

Joe S on 6/02/02 at 20:14 (086111)

The problem with alcohol injections is that they are very painful. Very Painful. They work though. The problem is finding someone who routinely does them. Gary Dockery, DPM is an authority on this particular subject. He is based out of Seattle.

Re: mortons neuroma

DR Zuckerman on 6/03/02 at 21:19 (086200)

The reason that they can be painful is the podiatrist is using marcaine and not lidocaine

Re: mortons neuroma

Joe S on 6/03/02 at 23:08 (086211)

Um OK. Let me stick a needle in your foot and inject 4% alcohol. It's very painful. Typically, it takes several shots.

Re: mortons neuroma

Joe S on 6/03/02 at 23:32 (086216)

Sounds like he didn't get it the first time. Once you resect the interdigital and common digital nerves they shouldn't comes back. The surgeon should've implanted the proximal end of the nerve into a muscle belly. This would have made it's recurrence far less.

Re: mortons neuroma

Pauline on 6/10/02 at 17:46 (087002)

I think the one thing that isn't being talk about is the effect an alcohol
injection has on a nerve. We talk about it as a treatment, but no one has spoken to the fact that it kills the nerve. If you have surgical removal of the neuroma, by it's very nature not only do you severe the nerve and gain numbness, but nerves heal by developing small neruomas on the cut ends. Depending on where these neuromas end up you could be back to square one as described by another poster.

No one mentioned using a wider shoe with a very low heel 1/2' that does put extra pressure on the ball of your foot. Repeated agravation by wearing heels continually irritate the problem.

Unfortunately style and a little vanity comes into play when you get a neruoma because we as women want to be stylish and love to wear heels. Most of the time this is what gives women many more foot problems than men---the design and willingness on our part to wear just about anything on our feet for fashion sake.

I have a neuroma and my decision was not to cut the nerve or to kill it by alcohol injection. I'm selfish and wanted to keep my nerve alive. I had luck with a steroid injection and resorting to eliminating heels from my shoe collection, using wider shoes and staying away form activities that I knew agravated it. The pain didn't go away over night. It took several months, but for me it worked. My nerve is still working, today I have no neruoma pain and I very rarely wear heels.

An alcohol injection is probably a sure cure because it will kill the nerve and trade feeling for numbness. Surgery will also cut the nerve trading feeling for numbness and can go either way. Maybe wider shoes, lower and the total elimination of heels, consistent rest (no dancing etc.) for a few months with the assistance of a steroid injection could help get rid of the pain associated with your neuroma. This will not remove the neuroma, but it might provide relief from your pain and your nerve would still be intact--no numbness.

Each of us are different, I tend to put a priority on keeping all my working parts as long as possible. I gave up the shoes to keep the nerve others might not give a second thought to killing this nerve. It's an individual decision based on your case and the success, failure or damage you can have with the various treatments available.

Re: mortons neuroma

Joe S on 6/10/02 at 21:15 (087025)

There are a few different ways by which a neuroma is surgically repaired. One is by excising the nerve and it's branches to the toe. Once severed, the nerve undergoes a process called Wallerian Degeneration. This is where the nerve begins to sprout new nerve endings in an attempt to provide sensation to the affected area of distribution. The nerve doesn't sprout new little neuroma's per se. If you happen to develop a stump neuroma then that is a different problem. A stump neuroma is where the severed nerve branch grows into the skin causing a very painful neuralgia (nerve pain). One way of combating this is by implanting the nerve stump into one of the adjacent muscle bellies. This will prevent the formation of the stump neuroma.

Some surgeons feel that releasing the intermetatarsal ligament that lies over the neuroma is all you should do. This does one of two things. It restores the sensation back to your digits and hopefully alleviates your pain. Or it does nothing. The one associated risk factor for this procedure is that it may not work. I will tell you, the last 3 'neuroma surgeries' that I performed, all I did was release the intermetarsal ligament. All 3 patients have done fine so far. Two of them are greater than 3 months post op and doing well. They all have feeling in their toes. There is some numbness over the incision which is not atypical for any surgery. Long term success is yet to be seen however. All three of these patients had underwent conservative care. My treatment protocol for 'neuroma symptoms' is #1 change in shoegear. #2 begin to wear an orthotic with metatarsal cookie to offload the met heads. #3 Neuroma injection in which I use a local anesthetic, a short acting steroid, a long acting steroid, and vitamin B12. I'll give max 3 injections.

Alcohol injections is a method by which sterile alcohol is injected around the nerve. It scleroses the nerve thereby destroying it. I don't do this due to the associated pain with the injection. I know of several doctors who do these exclusively with good success.

I believe that when you are in pain, you will do almost anything to get it better. As always, one should start with conservative measures and then become more aggressive if there is no improvement.

Re: mortons neuroma

Peggy P. on 6/11/02 at 13:09 (087124)

I wanted to comment that I've had the steroid combination injections and while it gave me some relief, I felt it wasn't enough. I have opted to try the alcohol injections because I live in NYC so driving is not an option for me. Not only do I have to walk everywhere -- I'm a fast walker, and limping around for almost eight weeks -- and not picking up my normal pace is ridiculous. I'm tyring to get over this and get on with my life. I can put my foot down when I walk but when I start to bend -- and put pressure on my toes I couldn't put them completely down because I would feel something almost like a muscle spasm -- because of the enlarged nerve. I also have a metatarsal problem so I've got two things going on. And I'm only wearing sketchers sneakers.

I understand about saving the nerve but I think if you live somewhere you can drive all the time that may effect the decision process of the alcohol injections but I felt the need to try this.

Right now, I hope to get good results with the sclerosing. My podiatrist performs many of these but I'm wondering why I didn't feel any pain with the injecting -- as I heard they are usually painful. Can you tell me if it's because my neuroma may be small -- or almost healed? Should I have felt pain for these injections to work? I've only felt a little ache when it wore off. I'm getting a second one in two weeks.

Thanks

Peggy

Re: mortons neuroma

Joe S on 6/11/02 at 20:09 (087198)

Everyone responds to injection therapy differently be it a steroid injection or an alcohol (sclerosing injection). Gary Dockery is a podiatrist in Seattle who has authored many papers on this subject. You can probably do a literature search on one of the medline queries regarding the overall effectiveness of this procedure. It is my philosophy that if you're in pain from this or whatever, then sacrificing a nerve to alleviate your pain is a viable option. It's kind of like when I went to the dentist about two weeks ago and he said well, you've got an abscessed tooth which is really decayed. When can perform a root canal but in 2 years you're gonna need a crown or an implant. I settled for having the tooth pulled and going ahead with the implant. I don't care about that stupid tooth that's been causing so much pain for such a long time. Anyway, good luck with the sclerosing injections. Please keep us posted.

Re: mortons neuroma

Peggy P. on 6/12/02 at 09:41 (087276)

Thanks but I seem to be plagued with another problem -- but not sure what it is or how to explain it. Ok -- I have a neuroma and a metatarsal problem. While it appears my metatarsal (ball of foot pain) has eased up and I can put my foot down completely while standing -- or even barefoot, it is when I begin to walk -- and take off -- I get a funny feeling in my fourth toe when taking off -- almost like a muscle spasm -- like I hit a nerve. Is this common? And is this related to my neuroma? This is frustrating and preventing me from walking normally. When I take my sneakers off and massage both the third and fourth toe I don't feel any pain. I don't believe my sneakers are tight in the toe area. It is so strange. I don't know what to do. I was wearing something called Ortha Heels purchased on line. While they did seem to help I thought I would go without them today because I was experiencing some heel and PF pain. Any help would be appreciated about the toes.

Re: mortons neuroma

Nancy M on 6/02/02 at 16:19 (086100)

Hi Joan,

I've had 3 neuromas removed. First time in my left foot between 3rd and 4th toe in June 1998. The other 2 at the same time - in left foot between 2nd and 3rd toe and in the right foot between the 2nd and 3rd toe in July 1999. I've had no problems from the surgeries until a month ago. I was told that they can come back and unfortunately it has in my left foot. Went to the doctor last Tuesday and received a shot, hasn't worked. Back to the doctor on June 11th probably for another shot. With the way my luck is with my feet I'll probably end up having surgery again. My doctor did tell me he also felt scar tissue in there. I can be standing or sitting with my feet up or down and just feel a burning wad in the ball of my foot.

Nancy M in AZ

Re: mortons neuroma

DR Zuckerman on 6/02/02 at 16:25 (086101)

Hi

Try having alcohol injections done. This is very effective had a very high rate of sucess and avoidance of neuroma foot surgery.

Re: mortons neuroma

Joe S on 6/02/02 at 20:14 (086111)

The problem with alcohol injections is that they are very painful. Very Painful. They work though. The problem is finding someone who routinely does them. Gary Dockery, DPM is an authority on this particular subject. He is based out of Seattle.

Re: mortons neuroma

DR Zuckerman on 6/03/02 at 21:19 (086200)

The reason that they can be painful is the podiatrist is using marcaine and not lidocaine

Re: mortons neuroma

Joe S on 6/03/02 at 23:08 (086211)

Um OK. Let me stick a needle in your foot and inject 4% alcohol. It's very painful. Typically, it takes several shots.

Re: mortons neuroma

Joe S on 6/03/02 at 23:32 (086216)

Sounds like he didn't get it the first time. Once you resect the interdigital and common digital nerves they shouldn't comes back. The surgeon should've implanted the proximal end of the nerve into a muscle belly. This would have made it's recurrence far less.

Re: mortons neuroma

Pauline on 6/10/02 at 17:46 (087002)

I think the one thing that isn't being talk about is the effect an alcohol
injection has on a nerve. We talk about it as a treatment, but no one has spoken to the fact that it kills the nerve. If you have surgical removal of the neuroma, by it's very nature not only do you severe the nerve and gain numbness, but nerves heal by developing small neruomas on the cut ends. Depending on where these neuromas end up you could be back to square one as described by another poster.

No one mentioned using a wider shoe with a very low heel 1/2' that does put extra pressure on the ball of your foot. Repeated agravation by wearing heels continually irritate the problem.

Unfortunately style and a little vanity comes into play when you get a neruoma because we as women want to be stylish and love to wear heels. Most of the time this is what gives women many more foot problems than men---the design and willingness on our part to wear just about anything on our feet for fashion sake.

I have a neuroma and my decision was not to cut the nerve or to kill it by alcohol injection. I'm selfish and wanted to keep my nerve alive. I had luck with a steroid injection and resorting to eliminating heels from my shoe collection, using wider shoes and staying away form activities that I knew agravated it. The pain didn't go away over night. It took several months, but for me it worked. My nerve is still working, today I have no neruoma pain and I very rarely wear heels.

An alcohol injection is probably a sure cure because it will kill the nerve and trade feeling for numbness. Surgery will also cut the nerve trading feeling for numbness and can go either way. Maybe wider shoes, lower and the total elimination of heels, consistent rest (no dancing etc.) for a few months with the assistance of a steroid injection could help get rid of the pain associated with your neuroma. This will not remove the neuroma, but it might provide relief from your pain and your nerve would still be intact--no numbness.

Each of us are different, I tend to put a priority on keeping all my working parts as long as possible. I gave up the shoes to keep the nerve others might not give a second thought to killing this nerve. It's an individual decision based on your case and the success, failure or damage you can have with the various treatments available.

Re: mortons neuroma

Joe S on 6/10/02 at 21:15 (087025)

There are a few different ways by which a neuroma is surgically repaired. One is by excising the nerve and it's branches to the toe. Once severed, the nerve undergoes a process called Wallerian Degeneration. This is where the nerve begins to sprout new nerve endings in an attempt to provide sensation to the affected area of distribution. The nerve doesn't sprout new little neuroma's per se. If you happen to develop a stump neuroma then that is a different problem. A stump neuroma is where the severed nerve branch grows into the skin causing a very painful neuralgia (nerve pain). One way of combating this is by implanting the nerve stump into one of the adjacent muscle bellies. This will prevent the formation of the stump neuroma.

Some surgeons feel that releasing the intermetatarsal ligament that lies over the neuroma is all you should do. This does one of two things. It restores the sensation back to your digits and hopefully alleviates your pain. Or it does nothing. The one associated risk factor for this procedure is that it may not work. I will tell you, the last 3 'neuroma surgeries' that I performed, all I did was release the intermetarsal ligament. All 3 patients have done fine so far. Two of them are greater than 3 months post op and doing well. They all have feeling in their toes. There is some numbness over the incision which is not atypical for any surgery. Long term success is yet to be seen however. All three of these patients had underwent conservative care. My treatment protocol for 'neuroma symptoms' is #1 change in shoegear. #2 begin to wear an orthotic with metatarsal cookie to offload the met heads. #3 Neuroma injection in which I use a local anesthetic, a short acting steroid, a long acting steroid, and vitamin B12. I'll give max 3 injections.

Alcohol injections is a method by which sterile alcohol is injected around the nerve. It scleroses the nerve thereby destroying it. I don't do this due to the associated pain with the injection. I know of several doctors who do these exclusively with good success.

I believe that when you are in pain, you will do almost anything to get it better. As always, one should start with conservative measures and then become more aggressive if there is no improvement.

Re: mortons neuroma

Peggy P. on 6/11/02 at 13:09 (087124)

I wanted to comment that I've had the steroid combination injections and while it gave me some relief, I felt it wasn't enough. I have opted to try the alcohol injections because I live in NYC so driving is not an option for me. Not only do I have to walk everywhere -- I'm a fast walker, and limping around for almost eight weeks -- and not picking up my normal pace is ridiculous. I'm tyring to get over this and get on with my life. I can put my foot down when I walk but when I start to bend -- and put pressure on my toes I couldn't put them completely down because I would feel something almost like a muscle spasm -- because of the enlarged nerve. I also have a metatarsal problem so I've got two things going on. And I'm only wearing sketchers sneakers.

I understand about saving the nerve but I think if you live somewhere you can drive all the time that may effect the decision process of the alcohol injections but I felt the need to try this.

Right now, I hope to get good results with the sclerosing. My podiatrist performs many of these but I'm wondering why I didn't feel any pain with the injecting -- as I heard they are usually painful. Can you tell me if it's because my neuroma may be small -- or almost healed? Should I have felt pain for these injections to work? I've only felt a little ache when it wore off. I'm getting a second one in two weeks.

Thanks

Peggy

Re: mortons neuroma

Joe S on 6/11/02 at 20:09 (087198)

Everyone responds to injection therapy differently be it a steroid injection or an alcohol (sclerosing injection). Gary Dockery is a podiatrist in Seattle who has authored many papers on this subject. You can probably do a literature search on one of the medline queries regarding the overall effectiveness of this procedure. It is my philosophy that if you're in pain from this or whatever, then sacrificing a nerve to alleviate your pain is a viable option. It's kind of like when I went to the dentist about two weeks ago and he said well, you've got an abscessed tooth which is really decayed. When can perform a root canal but in 2 years you're gonna need a crown or an implant. I settled for having the tooth pulled and going ahead with the implant. I don't care about that stupid tooth that's been causing so much pain for such a long time. Anyway, good luck with the sclerosing injections. Please keep us posted.

Re: mortons neuroma

Peggy P. on 6/12/02 at 09:41 (087276)

Thanks but I seem to be plagued with another problem -- but not sure what it is or how to explain it. Ok -- I have a neuroma and a metatarsal problem. While it appears my metatarsal (ball of foot pain) has eased up and I can put my foot down completely while standing -- or even barefoot, it is when I begin to walk -- and take off -- I get a funny feeling in my fourth toe when taking off -- almost like a muscle spasm -- like I hit a nerve. Is this common? And is this related to my neuroma? This is frustrating and preventing me from walking normally. When I take my sneakers off and massage both the third and fourth toe I don't feel any pain. I don't believe my sneakers are tight in the toe area. It is so strange. I don't know what to do. I was wearing something called Ortha Heels purchased on line. While they did seem to help I thought I would go without them today because I was experiencing some heel and PF pain. Any help would be appreciated about the toes.