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

Neuroma surgery/sclerosing - continued pain

Posted by Sheila S on 11/01/02 at 04:19 (098873)

I have had surgery twice on the same foot for Morton's Neuroma. The first doctor removed something, but I had worse (and constant) pain from that point on. One year later, I went to another doctor (mostly because I'd lost confidence in the first, but both are well respected and good surgeons, I believe) who determined there was a second neuroma in the same place and some obvious continued nerve contact that shouldn't have been there. I had surgery again in January 2002. He removed a neuroma and looked as deeply and thoroughly as possible and found no other possible cause of pain. I am STILL in constant pain.

We tried 7 sclerosing shots.... one shot, the 4th, apparently hit the mark and my foot swelled the next day and was extremely sore (apparently, ususally when this happens the patient suddenly begins to see much improvement). I think I can say I'm a tiny bit improved...but not enough to say I'm definitely improved and nowhere near enough to rate the discomfort as 'tolerable'. My doctor is just about as disappointed as I am - he's had great success with this procedure with original neuroma patients and has not had to perform a single surgery since he started using the sclerosing injections.

Has anyone else had a similar problem? Does anyone have any other suggestions or options to try? More than even the ability to walk and stand comfortably, I miss riding my horses...it's the most painful thing for me to do now.

Prior to the first surgery, my pain was only occasional but extreme (fiery, unbearable pain that shot to my toes and all the way to my knee!). Post-surger(ies) the pain is very local in the one spot and much like a good, strong smack on the 'funny bone' in your elbow - but always, with every step (particularly in the mornings when I first bear weight on it).

Is there a chemical (other than sclerosing) that can permanently deaden that nerve? A permanent nerve block? My foot feels SO good right after the sclerosing injection (which includes temporary numbing medicine). I'd rather take the risk of permanent nerve block than live my life as I'm forced to now.....

Thanks for your time!
Sheila

Re: Neuroma surgery/sclerosing - continued pain

Kathy G on 11/01/02 at 08:50 (098884)

Sheila,

I'm so sorry to hear of your problem. Do you wear custom orthotics? Have you tried taking anti-inflammatories? Did you have cortisone shots? I'm assuming you probably tried all of these before the surgeries.

I, too, was first diagnosed as having a Morton's Neuroma. My Pod, in whom I have the utmost of condfidence, did not operate because although I experienced the sharp, fiery pain in my big toe, the actual source was not in the area where the majority of people experience the problem. My 'neuroma' was between my third and fourth toes and upon consultation with his colleague, it was decided to treat it as an 'atypical Morton's Neuroma' without doing surgery. For a few years, I got by with anti-inflammatories and inserts. Then for a couple of years, I had cortisone shots, no more than once every 5 months. He kept mentioning custom orthotics but I resisted until such time that I started to exhibit symptoms of PF as well as the neuroma and I relented. It was the best thing I've ever done. Although I still have pain, it's much decreased. I seldom experience pain from the neuroma. When I attended a couple of weddings this summer, and wore different shoes and no orthotics, it started to bother me. As soon as I put back on my running shoes and orthotics, it was much improved. Recently I had my two-year old orthotics relined because I was starting to have discomfort in the area of the neuroma, even in the running shoes, and I wanted to nip it in the bud. So far so good.

I know I haven't been of much help to you and I hope one of the doctors or other posters have more useful suggestions. Because this is a PF board, not too many others have experienced the pain of a neuroma. I found the PF to be more debilitating but it presents a different type of pain. I can easily tell the difference between which condition is causing my dicomfort. I used to describe it as getting an electric shock in my toe. I'd be sitting down and it would hit and I would actually gasp or cry out in pain, it was so sharp. It's definitely not fun and I can't even imagine how much pain you must be experiencing, not to mention your frustration. I certainly hope that you can get some relief and eventually get back to riding. In the meantime, hang in there and visit our Support board. You'll find some very nice people there who have also experienced pain and inactivity due to foot problems. Sometimes it's nice to be able to vent among people with similar problems and you'll be amazed at how many helpful suggestions you'll receive.

Good luck!

Re: Neuroma surgery/sclerosing - continued pain

BrianG on 11/01/02 at 17:54 (098961)

Hi Sheila,

I'm sorry that I can't answer your question, but thought I'd ask you about the sclerosing injections. A few years ago I had 4 Prolotherapy injections into one heel, for PF. I'm wondering if it is the same thing, differnt name? The Prolotheray injections were made up of a natural irritant, that when injected, would supposedly injure that area, causing the body to heal it.

My injections were sugar based, the doctor said that some other injections were salt based, and even pumice. I just went to the Net to see what I could find. Not much!! There was one small article about a Podiatrist injecting B12 into the heel for PF, but it was a very small study, about 20 people. The results were inconclusive.

Do you know what your injections contained? I know mine were very painful, as the doctor used very little Lidocaine. Unfortunatly I was not helped, and we stopped at 4 injections. Not to mention my insurance would only pay for the office visit, not the injection. Each injection was $100, plus the office visit!!

Good luck on the healing
BrianG

PS: I'm not sure the doctors will go from the 'ask the doctor' page, to this one. The are always busy. You may have better luck to cut and paste this question, over to the 'ask the Doctor' section.

Re: Neuroma surgery/sclerosing - continued pain

Sheila S on 11/01/02 at 20:03 (098968)

Hi Brian,
Thanks for your suggestion on the doctor's page...I didn't think about it since I saw posts from the physician's here also.

Do a search on 'Neuroma & Sclerosing' and you'll find lots of information!! Even just on 'sclerosing' there are alot of articles and things to search. It seems sclerosing is being used more and more as a last resort before surgery, and working very well in most cases.

As I understand it the Prolotherapy is pretty much the same thing (or maybe even the exact same thing) except, today, sclerosing is almost exclusively a 4% alcholol solution for the active ingredient. Along with a local anesthetic. But the action is not as you described (in fact, I doubt your shot was even as the doctor explained). Sclerosing was primarly used for getting rid of spider veins. The alcohol affects the nerve, or scars the nerve, rendering it 'non-functional' or in simple terms, it's a nerve block or chemical neurolysis. http://213.176.1.196:800/Default/www.biomech.com/current/pain.shtml is a good article and http://www.drjcgraham.com/med_article9.htm has some good info. on the ingredients.

The shots are no more painful than the cortisone shots in general. (The one that hit 'bullseye' was quite painful but not intolerable.) I would recommend them to anyone as a possible solution before undergoing surgery....for any nerve problem. Although I'm sure alot of doctors would disagree. (My shots were $225 each and insurance covered 80% of it. Because my doctor had already done surgery, he accepted the insurance payment and did not bill me the 20%.)

Hope this helps you!
Sheila

Re: Neuroma surgery/sclerosing - continued pain

BrianG on 11/01/02 at 22:22 (098978)

Hi Sheila,

Your information was fairly easy to understand. Prolo and Sclero sound like they could be first cousins. They are definatly different procedures though. Prolo is mostly used for tendons and ligamets, while Sclero is used for nerves. I have cut and pasted a little bit that I got from http://www.prolotherapy.com . The Sclerosing is something new to me, but thank god, I don't have nerve problems, yet! I have talked to a few others who had Prolo for heel pain, none got relief:*( Here it is:

BrianG

Prolotherapy is also known as nonsurgical ligament reconstruction,
and is a treatment for chronic pain
Prolotherapy is helpful for what conditions?
The treatment is useful for many different types of musculoskeletal pain, including arthritis, back pain, neck pain, fibromyalgia, sports injuries, unresolved whiplash injuries, carpal tunnel syndrome, partially torn tendons, ligaments and cartilage, degenerated or herniated discs, TMJ and sciatica.
What is prolotherapy?
First, it is important to understand what the word prolotherapy itself means. 'Prolo' is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.
Ligaments are the structural 'rubber bands' that hold bones to bones in joints. Ligaments can become weak or injured and may not heal back to their original strength or endurance. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings and therefore the person will feel pain at the areas where the ligaments are damaged or loose.
Tendons are the name given to tissue which connects muscles to bones, and in the same manner tendons may also become injured, and cause pain.
Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.
Historical review shows that a version of this technique was first used by Hippocrates on soldiers with dislocated, torn shoulder joints. He would stick a hot poker into the joint, and it would then miraculously heal normally. Of course, we don't use hot pokers today, but the principle is similar get the body to repair itself, an innate ability that the body has.
How long will it take to complete a course of treatments?
The response to treatment varies from individual to individual, and depends upon one's healing ability. Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated. The best thing to do is get an evaluation by a trained physician to see if you are an appropriate candidate. Once you begin treatment, your doctor can tell better how you are responding and give you an accurate estimate. Dr. Alderman gives evaluations and has successfully treated a wide range of patients who have come southern California and surrounding states as well as Hawaii.
Home (PIPE) What is it? (PIPE) Can it help me? (PIPE) Where to get it (PIPE) More info

Re: Neuroma surgery/sclerosing - continued pain

Dr. Z on 11/02/02 at 09:57 (099012)

Hi

This is a very frustating problem. Here are some thing to think about.
1 Do you have hammers toes on this foot. Do have any plantarflexed metatarsal heads on this foot

2. Does you podiatrist think you have a'stump' neuroma. This is where after cutting the nerve some of the nerve grows back and then is attached to the bottom of the metatarsal head

3. Sometimes if you wear a laced shoe and you skip the last eylette it will give the foot just a bit more room so the nerve isn't being compressed.

4. It is very important after the alcohol injection that a metatarsal pad is placed under the foot to move the weight of the adjacent bones away from the nerve

I hope that this is helpful to you.

Re: Neuroma surgery/sclerosing - continued pain

Sheila S on 11/02/02 at 17:16 (099084)

Thank you for responding Dr.Z. I do not have hammer toes. I don't know about plantarflexed metatarsal heads, but I will ask on Monday. I think (assume only as he hasn't really said) that my doctor isn't really sure what the problem is, but thought probably a stump neuroma. Although I've not heard before that it attaches itself to the metatarsal. I'm the only patient he's ever had like this.

This particular pain began after the first surgery, by a different doctor, and my current doctor said that when he performed the second surgery he looked around as thoroughly as possible to see if he could find/see anything else, and he didn't. He did remove another neuroma.

I am going to try orthotics for walking, but I don't believe they will help riding my horses due to the position and flex of the foot when pressure is placed in the stirrup.

I have not had a metatarsal pad at all. Should it have been used constantly since beginning the shots? or after the series was completed? I don't think my doctor is aware of this as he's not mentioned it, he hasn't mentioned orthotics either. (I've just read about it and a friend who's daughter is a doctor suggested I go see someone about them.)

My fourth toe is pretty numb on the inside, and my third toe is only somewhat numb on the inside. And that third toe is where the pain radiates to and directly under that side of the metatarsal joint between 3rd & 4th toes. There is no pain in the 4th toe at all nor on the 4th metatarsal. I can feel the tendon snap and pop on something there when I flex my toes or walk (or, I assume it's tendon?).

My doctor seems frustrated and puzzled, also and disappointed, the shots didn't work. He also knows I do alot of research and told me to let him know if I found anything new or helpful. And I will mention to him any and all possibilities you've suggested as something to research.

I have asked him, 3 times, if there isn't SOME kind of test, MRI, etc., that might show something and he said 'no, not really', and that the expense was large for the tests.

I don't know what to think.

Re: neuroma in adjacent interspace

Ed Davis, DPM on 11/04/02 at 14:36 (099305)

Occasionally I have found neuromas in adjacent interspaces which mimick neuroma symptoms in the 'affected' area. This hypothesis can be tested by injecting some lidocaine in adjacent interspaces.
Ed

Re: Neuroma surgery/sclerosing - continued pain

Kathy G on 11/01/02 at 08:50 (098884)

Sheila,

I'm so sorry to hear of your problem. Do you wear custom orthotics? Have you tried taking anti-inflammatories? Did you have cortisone shots? I'm assuming you probably tried all of these before the surgeries.

I, too, was first diagnosed as having a Morton's Neuroma. My Pod, in whom I have the utmost of condfidence, did not operate because although I experienced the sharp, fiery pain in my big toe, the actual source was not in the area where the majority of people experience the problem. My 'neuroma' was between my third and fourth toes and upon consultation with his colleague, it was decided to treat it as an 'atypical Morton's Neuroma' without doing surgery. For a few years, I got by with anti-inflammatories and inserts. Then for a couple of years, I had cortisone shots, no more than once every 5 months. He kept mentioning custom orthotics but I resisted until such time that I started to exhibit symptoms of PF as well as the neuroma and I relented. It was the best thing I've ever done. Although I still have pain, it's much decreased. I seldom experience pain from the neuroma. When I attended a couple of weddings this summer, and wore different shoes and no orthotics, it started to bother me. As soon as I put back on my running shoes and orthotics, it was much improved. Recently I had my two-year old orthotics relined because I was starting to have discomfort in the area of the neuroma, even in the running shoes, and I wanted to nip it in the bud. So far so good.

I know I haven't been of much help to you and I hope one of the doctors or other posters have more useful suggestions. Because this is a PF board, not too many others have experienced the pain of a neuroma. I found the PF to be more debilitating but it presents a different type of pain. I can easily tell the difference between which condition is causing my dicomfort. I used to describe it as getting an electric shock in my toe. I'd be sitting down and it would hit and I would actually gasp or cry out in pain, it was so sharp. It's definitely not fun and I can't even imagine how much pain you must be experiencing, not to mention your frustration. I certainly hope that you can get some relief and eventually get back to riding. In the meantime, hang in there and visit our Support board. You'll find some very nice people there who have also experienced pain and inactivity due to foot problems. Sometimes it's nice to be able to vent among people with similar problems and you'll be amazed at how many helpful suggestions you'll receive.

Good luck!

Re: Neuroma surgery/sclerosing - continued pain

BrianG on 11/01/02 at 17:54 (098961)

Hi Sheila,

I'm sorry that I can't answer your question, but thought I'd ask you about the sclerosing injections. A few years ago I had 4 Prolotherapy injections into one heel, for PF. I'm wondering if it is the same thing, differnt name? The Prolotheray injections were made up of a natural irritant, that when injected, would supposedly injure that area, causing the body to heal it.

My injections were sugar based, the doctor said that some other injections were salt based, and even pumice. I just went to the Net to see what I could find. Not much!! There was one small article about a Podiatrist injecting B12 into the heel for PF, but it was a very small study, about 20 people. The results were inconclusive.

Do you know what your injections contained? I know mine were very painful, as the doctor used very little Lidocaine. Unfortunatly I was not helped, and we stopped at 4 injections. Not to mention my insurance would only pay for the office visit, not the injection. Each injection was $100, plus the office visit!!

Good luck on the healing
BrianG

PS: I'm not sure the doctors will go from the 'ask the doctor' page, to this one. The are always busy. You may have better luck to cut and paste this question, over to the 'ask the Doctor' section.

Re: Neuroma surgery/sclerosing - continued pain

Sheila S on 11/01/02 at 20:03 (098968)

Hi Brian,
Thanks for your suggestion on the doctor's page...I didn't think about it since I saw posts from the physician's here also.

Do a search on 'Neuroma & Sclerosing' and you'll find lots of information!! Even just on 'sclerosing' there are alot of articles and things to search. It seems sclerosing is being used more and more as a last resort before surgery, and working very well in most cases.

As I understand it the Prolotherapy is pretty much the same thing (or maybe even the exact same thing) except, today, sclerosing is almost exclusively a 4% alcholol solution for the active ingredient. Along with a local anesthetic. But the action is not as you described (in fact, I doubt your shot was even as the doctor explained). Sclerosing was primarly used for getting rid of spider veins. The alcohol affects the nerve, or scars the nerve, rendering it 'non-functional' or in simple terms, it's a nerve block or chemical neurolysis. http://213.176.1.196:800/Default/www.biomech.com/current/pain.shtml is a good article and http://www.drjcgraham.com/med_article9.htm has some good info. on the ingredients.

The shots are no more painful than the cortisone shots in general. (The one that hit 'bullseye' was quite painful but not intolerable.) I would recommend them to anyone as a possible solution before undergoing surgery....for any nerve problem. Although I'm sure alot of doctors would disagree. (My shots were $225 each and insurance covered 80% of it. Because my doctor had already done surgery, he accepted the insurance payment and did not bill me the 20%.)

Hope this helps you!
Sheila

Re: Neuroma surgery/sclerosing - continued pain

BrianG on 11/01/02 at 22:22 (098978)

Hi Sheila,

Your information was fairly easy to understand. Prolo and Sclero sound like they could be first cousins. They are definatly different procedures though. Prolo is mostly used for tendons and ligamets, while Sclero is used for nerves. I have cut and pasted a little bit that I got from http://www.prolotherapy.com . The Sclerosing is something new to me, but thank god, I don't have nerve problems, yet! I have talked to a few others who had Prolo for heel pain, none got relief:*( Here it is:

BrianG

Prolotherapy is also known as nonsurgical ligament reconstruction,
and is a treatment for chronic pain
Prolotherapy is helpful for what conditions?
The treatment is useful for many different types of musculoskeletal pain, including arthritis, back pain, neck pain, fibromyalgia, sports injuries, unresolved whiplash injuries, carpal tunnel syndrome, partially torn tendons, ligaments and cartilage, degenerated or herniated discs, TMJ and sciatica.
What is prolotherapy?
First, it is important to understand what the word prolotherapy itself means. 'Prolo' is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.
Ligaments are the structural 'rubber bands' that hold bones to bones in joints. Ligaments can become weak or injured and may not heal back to their original strength or endurance. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings and therefore the person will feel pain at the areas where the ligaments are damaged or loose.
Tendons are the name given to tissue which connects muscles to bones, and in the same manner tendons may also become injured, and cause pain.
Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.
Historical review shows that a version of this technique was first used by Hippocrates on soldiers with dislocated, torn shoulder joints. He would stick a hot poker into the joint, and it would then miraculously heal normally. Of course, we don't use hot pokers today, but the principle is similar get the body to repair itself, an innate ability that the body has.
How long will it take to complete a course of treatments?
The response to treatment varies from individual to individual, and depends upon one's healing ability. Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated. The best thing to do is get an evaluation by a trained physician to see if you are an appropriate candidate. Once you begin treatment, your doctor can tell better how you are responding and give you an accurate estimate. Dr. Alderman gives evaluations and has successfully treated a wide range of patients who have come southern California and surrounding states as well as Hawaii.
Home (PIPE) What is it? (PIPE) Can it help me? (PIPE) Where to get it (PIPE) More info

Re: Neuroma surgery/sclerosing - continued pain

Dr. Z on 11/02/02 at 09:57 (099012)

Hi

This is a very frustating problem. Here are some thing to think about.
1 Do you have hammers toes on this foot. Do have any plantarflexed metatarsal heads on this foot

2. Does you podiatrist think you have a'stump' neuroma. This is where after cutting the nerve some of the nerve grows back and then is attached to the bottom of the metatarsal head

3. Sometimes if you wear a laced shoe and you skip the last eylette it will give the foot just a bit more room so the nerve isn't being compressed.

4. It is very important after the alcohol injection that a metatarsal pad is placed under the foot to move the weight of the adjacent bones away from the nerve

I hope that this is helpful to you.

Re: Neuroma surgery/sclerosing - continued pain

Sheila S on 11/02/02 at 17:16 (099084)

Thank you for responding Dr.Z. I do not have hammer toes. I don't know about plantarflexed metatarsal heads, but I will ask on Monday. I think (assume only as he hasn't really said) that my doctor isn't really sure what the problem is, but thought probably a stump neuroma. Although I've not heard before that it attaches itself to the metatarsal. I'm the only patient he's ever had like this.

This particular pain began after the first surgery, by a different doctor, and my current doctor said that when he performed the second surgery he looked around as thoroughly as possible to see if he could find/see anything else, and he didn't. He did remove another neuroma.

I am going to try orthotics for walking, but I don't believe they will help riding my horses due to the position and flex of the foot when pressure is placed in the stirrup.

I have not had a metatarsal pad at all. Should it have been used constantly since beginning the shots? or after the series was completed? I don't think my doctor is aware of this as he's not mentioned it, he hasn't mentioned orthotics either. (I've just read about it and a friend who's daughter is a doctor suggested I go see someone about them.)

My fourth toe is pretty numb on the inside, and my third toe is only somewhat numb on the inside. And that third toe is where the pain radiates to and directly under that side of the metatarsal joint between 3rd & 4th toes. There is no pain in the 4th toe at all nor on the 4th metatarsal. I can feel the tendon snap and pop on something there when I flex my toes or walk (or, I assume it's tendon?).

My doctor seems frustrated and puzzled, also and disappointed, the shots didn't work. He also knows I do alot of research and told me to let him know if I found anything new or helpful. And I will mention to him any and all possibilities you've suggested as something to research.

I have asked him, 3 times, if there isn't SOME kind of test, MRI, etc., that might show something and he said 'no, not really', and that the expense was large for the tests.

I don't know what to think.

Re: neuroma in adjacent interspace

Ed Davis, DPM on 11/04/02 at 14:36 (099305)

Occasionally I have found neuromas in adjacent interspaces which mimick neuroma symptoms in the 'affected' area. This hypothesis can be tested by injecting some lidocaine in adjacent interspaces.
Ed

Re: Re:Pain concern

Julie C on 3/11/08 at 07:11 (244378)

I have a concern about my neuroma surgery that took place 2 1/2 years ago. I had the surgery and have been pain free up until 4 nights ago when I was awaken from a dead sleep from the pain in my toe. It's the 4th digit on my right foot. It's numb but the pain is really bad. What could this be? I feel as if every pain in my body has found a home in my toe. I do not have stabbing pain or radiating pain.
Is there a certain Alpha blocker I should take to relieve this pain? Regular NSAIDS do not relieve the pain.

Thanks for listening.

Julie

Re: Neuroma surgery/sclerosing - continued pain

Lesley on 1/22/09 at 11:57 (254245)

I managed to control neuroma pain for 14 years with the use of good custom orthotics while dancing. It took about 4 months of constant orthotic wear to start feeling good again; after that I wore the orthotics for 2 years while dancing only (that's how I got the neuromas in the first place -- narrow dance shoes). I believe that some doctors don't suggest them because they do take dedication of the patient to make them work. If you have never worn them before, there is a substantial break-in period and you may not feel comfortable for a couple of weeks. I even had back pain during the adjustment process. I think this is where most patients quit. Plus, you will probably need to buy new shoes to accommodate the orthotics (flats, a half-size larger, lace-ups worked best for me). Further, it can be a challenge finding a talented orthotics technician. I ALWAYS buy my orthotics from someone who makes them on site (not sends the casting mold away in the mail) so if you need an adjustment or two, they can do it right there while you wait. I have also found technicians who couldn't even understand the prescription, so be sure you go someplace with a good reputation.

After 14 years of control, my neuroma flared up again after bunion surgery. I am in the process of trying to get it under control again, but my doctor thinks that I ought to go ahead and have the surgery this time. We'll see.