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New thoughts from seminar? Dr's. opinions please...

Posted by Sheila S on 11/26/02 at 05:02 (101166)

Hello again Doctors,

My C-ped (B.O.C., P.O.) was telling me about a convention he went to in Nashville at the end of last week and one of the seminars was by Dr. Ian Alexander - 8 hours worth - on neuromas. He believes that most fo the time it is nearly impossible to completely sever the nerve far enough away from the mets to avoid further problems and pain, without going in through the bottom of the foot - or else completely mapping it before surgery. (and forgive me if I'm not saying/explaining this correctly.)

My C-ped told me about him because he said that everything Dr. Alexander was describing sounded exactly like the problems I am having.

Any thoughts from you on this???

Thanks,
Sheila

Re: New thoughts from seminar? Dr's. opinions please...

Dr. John Cozzarelli on 11/26/02 at 06:31 (101170)

Hi Sheila:

When performing this surgery the nerve needs to be tracted very proximal to avoid mechanical compression of the metatarsal heads. The incision is made on the top of the foot. It can be peformed on the bottom. I prefer the top. The nerve when severed to avoid stump neuroma needs to be retracted in the skeletal muscle and or placed on the side of the metatarsal shaft. Theses areas have inervation already and will not use this nerve. I hope this clears the concept for you.

Dr. John Cozzarelli

Re: New thoughts from seminar? Dr's. opinions please...

Sheila S. on 11/27/02 at 14:37 (101265)

Thanks for your answer, Dr. Cozzarelli.

Dr. Alexander was saying that going through the top of the foot will make it almost impossible for the nerve to be servered as far back as it needs to be. His opinion was that one MUST go through the bottom of the foot in order to thoroughly cut the nerve because it can not be completely seen from the top of the foot. That's what I was questioning....

I question, because I've had the surgery in the same place, twice, from the top of my foot and still have horrible pain. It is not stump neuroma nor scar tissue causing it because it began immediately following the first surgery, before I was even out of the boot. So, about 10 months later I went to another doctor, he thought he felt a second neuroma in the same space that the first surgeon missed, thus a second surgery which we hoped would solve the problem. He did find and remove a second neuroma, and could SEE nothing else at ALL that could cause problems... and the horrible pain continues unabated.

It is not a neuroma in an adjacent space. I can feel exactly the pin-point spot that it hurts. Right at the left side of the 3rd met on my left foot (surgery was between 3&4). I feel something snap and pop as it rolls around the bone. And it hurts like...heck.

So, I'm trying to find out what my problem is....and not being real successful. But Dr. Alexander's opinion makes alot of sense in my case... (??)

Re: New thoughts from seminar? Dr's. opinions please...

Dr. John Cozzarelli on 11/27/02 at 20:59 (101293)

Hey Shiela:

I would get a diagnostic ultrasound of the foot and or MRI of the foot before I had another surgery. Confirm what is wrong.

Dr, john Cozzarelli

Re: New thoughts from seminar? Dr's. opinions please...

Dr. John Cozzarelli on 11/26/02 at 06:31 (101170)

Hi Sheila:

When performing this surgery the nerve needs to be tracted very proximal to avoid mechanical compression of the metatarsal heads. The incision is made on the top of the foot. It can be peformed on the bottom. I prefer the top. The nerve when severed to avoid stump neuroma needs to be retracted in the skeletal muscle and or placed on the side of the metatarsal shaft. Theses areas have inervation already and will not use this nerve. I hope this clears the concept for you.

Dr. John Cozzarelli

Re: New thoughts from seminar? Dr's. opinions please...

Sheila S. on 11/27/02 at 14:37 (101265)

Thanks for your answer, Dr. Cozzarelli.

Dr. Alexander was saying that going through the top of the foot will make it almost impossible for the nerve to be servered as far back as it needs to be. His opinion was that one MUST go through the bottom of the foot in order to thoroughly cut the nerve because it can not be completely seen from the top of the foot. That's what I was questioning....

I question, because I've had the surgery in the same place, twice, from the top of my foot and still have horrible pain. It is not stump neuroma nor scar tissue causing it because it began immediately following the first surgery, before I was even out of the boot. So, about 10 months later I went to another doctor, he thought he felt a second neuroma in the same space that the first surgeon missed, thus a second surgery which we hoped would solve the problem. He did find and remove a second neuroma, and could SEE nothing else at ALL that could cause problems... and the horrible pain continues unabated.

It is not a neuroma in an adjacent space. I can feel exactly the pin-point spot that it hurts. Right at the left side of the 3rd met on my left foot (surgery was between 3&4). I feel something snap and pop as it rolls around the bone. And it hurts like...heck.

So, I'm trying to find out what my problem is....and not being real successful. But Dr. Alexander's opinion makes alot of sense in my case... (??)

Re: New thoughts from seminar? Dr's. opinions please...

Dr. John Cozzarelli on 11/27/02 at 20:59 (101293)

Hey Shiela:

I would get a diagnostic ultrasound of the foot and or MRI of the foot before I had another surgery. Confirm what is wrong.

Dr, john Cozzarelli