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For Dr. Z - Answers to your questions

Posted by Sheila on 11/06/02 at 05:04 (099483)

Re: 2 Surgeries and Sclerosing - and still so much pain...
Posted by Dr. Z on 11/03/02 at 21:22
If the tendon is snapping it could be that the joint is unstable and that is where your pain is coming from. This can be determined by an examination. The lenght of the toes could be abnormal . Yes an MRI could help but I don't believe it is going to add to anything. I really believe your problem is in the MPJ alignment or the toe alignment. When they did the second neuroma surgery was the incision on the bottom of the foot or one the top

Reply to Message # 99223

Re: 2 Surgeries and Sclerosing - and still so much pain...
Posted by Sheila on 11/04/02 at 04:43
The incision was in the top of my foot, exact same place for both surgeries. And the pain began before there would have been much scar tissue, immediately following the first surgery (as soon as I could wear tennis shoes again). As a side note, my mother and grandmother had active psoriasis (I don't); I mention this because I had one Pod. tell me a few years ago that this could cause problems with healing and excessive scar tissue (when I had my big toenails cut on each side and laser done for ingrown toenails). I am rather flat-footed - no one's told me this - I base it on my wet footprints, they're very wide in the center where I see that other people's show a narrow strip on the outside... very clinical! =)

[I still wonder if a neuroma was the problem in the very first place, is it typical for the pain to be only on occasion and shoot all the way up the leg? I was riding my horse, suddenly it was fiery, unbearable, burning pain from that area all the way up my leg. It was not immediately relieved when I took my riding boot off (not cowboy boots, but soft suede 'ropers' with a rubber sole, they feel and fit much like a tennis shoe with a heel). Over a period of 6 months or so this happened 3 or 4 times when I finally went to a Podiatrist. I decided to have the second surgery when I was at work one day, got up to walk around my desk and whatever is in there 'pinched' and wouldn't let up, I couldn't put my foot down at all (no pain as long as I held my foot up though). I had to get a ride home and be helped into the house. I layed down for about 20 mins. and when I got up to go to the bathroom it was fine.]

I'm trying to give you all the information I can possibly think of to assist in possibilities....as I said, I will pass on any possible research ideas to my Podiatrist...and will give him the website information if he wishes to consult with some of you. I believe he's a good doctor, but I am also at the point of feeling maybe I should try to find someone at perhaps UVA or somewhere...

AGAIN, many thanks to all of you for your consideration. It is much appreciated.
Sheila

Reply to Message # 99242

Re: Neuroma surgery/sclerosing - continued pain
Posted by Dr. Z on 11/02/02 at 09:57
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.

Reply to Message # 99012

Re: Neuroma surgery/sclerosing - continued pain
Posted by Sheila S on 11/02/02 at 17:16
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: For Dr. Z - Answers to your questions

JoV on 11/07/02 at 21:46 (099612)

I am having spur surgery on two toes next week. Is this very involved? It will be done in the Doctor's office. Will I need a ride home?

Re: Dr. Z ..... any further suggestions or questions????

Sheila S on 11/10/02 at 14:19 (099722)

Noticed you hadn't seen this yet.....

Re: Dr. Z ..... any further suggestions or questions????

Dr. Z on 11/10/02 at 15:14 (099723)

I would try the metatarsal padding. Let me know if that helps your foot pain. It is very difficult to evaluate your foot without a hands on examination. Sorry but the met padding is my only help at this time

Re: Dr. Z ..... any further suggestions or questions????

Sheila S on 11/11/02 at 05:36 (099759)

Thank you! I am trying the met pads and they do seem to be helping in my walking. Normans Custom Shoes gave me some pre-made arch support/met pad inserts. I go back in 2 days for him to thicken the pad. He said both the 3rd & 4th met. heads have dropped, he can still see some swelling, and feels the pads will help. He wants to make the left one a little larger and thicker but said he needed to do it over time so I could get used to it. If these are successful, he can make some for my other shoes. My foot imprint showed heavy weight on the 3rd & 4th mets. My tennis shoe heels also show wear on the outsides which he is going to work on as well. I'm buying some new tennis shoes today to see if maybe the foot pain has caused me to walk on the outsides - and to get realigned properly.

Thanks for your help and suggestions. I will keep copies in case more research is needed. I am sorry you are so far away, you seem to be the only one not recommending MORE surgery.....

Many many thanks!
Sheila

Re: For Dr. Z - Answers to your questions

JoV on 11/07/02 at 21:46 (099612)

I am having spur surgery on two toes next week. Is this very involved? It will be done in the Doctor's office. Will I need a ride home?

Re: Dr. Z ..... any further suggestions or questions????

Sheila S on 11/10/02 at 14:19 (099722)

Noticed you hadn't seen this yet.....

Re: Dr. Z ..... any further suggestions or questions????

Dr. Z on 11/10/02 at 15:14 (099723)

I would try the metatarsal padding. Let me know if that helps your foot pain. It is very difficult to evaluate your foot without a hands on examination. Sorry but the met padding is my only help at this time

Re: Dr. Z ..... any further suggestions or questions????

Sheila S on 11/11/02 at 05:36 (099759)

Thank you! I am trying the met pads and they do seem to be helping in my walking. Normans Custom Shoes gave me some pre-made arch support/met pad inserts. I go back in 2 days for him to thicken the pad. He said both the 3rd & 4th met. heads have dropped, he can still see some swelling, and feels the pads will help. He wants to make the left one a little larger and thicker but said he needed to do it over time so I could get used to it. If these are successful, he can make some for my other shoes. My foot imprint showed heavy weight on the 3rd & 4th mets. My tennis shoe heels also show wear on the outsides which he is going to work on as well. I'm buying some new tennis shoes today to see if maybe the foot pain has caused me to walk on the outsides - and to get realigned properly.

Thanks for your help and suggestions. I will keep copies in case more research is needed. I am sorry you are so far away, you seem to be the only one not recommending MORE surgery.....

Many many thanks!
Sheila