neuroma treatmentPosted by John A on 2/15/03 at 08:38 (109208)
My foot doc told me that I have a neuroma about a year ago. Have had two series of steroid injections. Last did not make any improvement. I don't want surgery on it so doc suggested alcohol injections. He didn't give much info except that it kills the nerve. Sounds painful. Has anyone had this and how was it for pain, did it work??
Re: neuroma treatment-sclerosingSheila S on 2/15/03 at 09:04 (109218)
Sclerosing injections can work wonderfully. Do a search on 'sclerosing & neuroma' using Google (my favorite search engine) and you will gather lots of information including exactly how and why it works.
While the injections do not help with recurrent neuroma (my problem); my doctor has not had to do a single surgery since he began doing the sclerosing injections. Of course people are different and not all doctors have this great a success rate. But sclerosing is far cheaper than surgery and, in my opinion, worth a try prior to scheduling surgery, if nothing else has worked.
(I'm not a doctor - but have 'been there' )
Re: neuroma treatmentPauline on 2/15/03 at 09:04 (109220)
I too have had and still have a neuroma. Personally I think 'killing' a nerve is extreme. My guess is that your doctor is a Podiatrist. Before you do this get a second opinion from an Orthopedic Foot and Ankle Specialist. See if you can find one willing to 'kill' your nerve with alcohol injections. I rather doubt it. Consider all your options before you begin killing nerves or having any surgery.
Feet are more than things we just walk on. If someone told you to kill a nerve in your eye wouldn't you get a second opinion? Same holds true for your feet or any other part of your body. Don't be in such a hurry to kill off your nerves. If you don't like the Orthopedic physician's opinion you can always find someone out there willing and ready to 'kill' off your nerve when ever you say yes.
Re: neuroma treatmentDr. Z on 2/15/03 at 15:59 (109294)
You are not really killing the nerve. The alcohol injections will disrupt the pain receptors in the nerve. Here are some of the treatments that may or may
1. wider shoes, with extra toe box height. Or if you have laced shoes don't lace the last eyelet of the shoe.This will make the shoe wider
2. padding and or orthosis to move the metatarsal bone away from the nerve
3 Padding on the bottom of the foot
4. Local steriod injections : Done by most foot and ankel orthopedic surgeon. Can cause local damage to the fat padding
5. Multipe alcohol injections. Very effective and safe. First discoved by Dr. Steinberg who is a podiatrist in the early 1950's. Not done by the majority of foot and ankle orthpedic surgeon unless taught by a podiatrist or they studied the podiatric literature.
6. Excision of the neuroma. Has some complcations which can leave the foot more painful then before the surgery
I would go for the local alcohol injections with some type of padding or inserts to re-distribute the weight away from the adjacent metatarsal bone
First take a look at your shoes and see if they fit !!
Re: neuroma treatmentDr. David S. Wander on 2/15/03 at 16:14 (109299)
I won't even respond to Pauline's answer, but I will respond to your question. The treatment options for a neuroma include change of shoes, paddings/strappings, physical therapy (ultrasound, iontophoresis), orthoses, cortisone injections, sclerosing injections, surgical excision of the neuroma and release of the transverse metatarsal ligament.
Cortisone injections act by decreasing the inflammation of the nerve tissue. A neuroma is actually a 'perineural fibrosis'/thickening of the nerve tissue. The injection reduces inflammation and the fibrosis.
Sclerosing injections DO NOT 'KILL' the nerve, but atrophy the nerve tissue to 'shrink' the painful and symptomatic neuroma. This is no worse than surgically removing a neuroma, which is often performed by podiatrists and foot and ankle orthopedic surgeons. The atrophy of the nerve often results in dramatic relief of the symptoms and isn't as dramatic or traumatic as it sounds. The nerve is not a motor nerve, meaning that it is responsible for sensations, not motor movement. There are also other nerves to the digits, therefore a complete loss of sensation rarely results.
As stated, many podiatrists and foot and ankle orthopedic surgeons surgically remove a neuroma, which is often successful, but also has inherent complications. Once again, there is sometimes a slight decrease in sensation in the area following neuroma surgery. Surgery is certainly more traumatic than sclerosing injections and REMOVES the neuroma/section of nerve.
Recently, some doctors have had success releasing the ligament that overlies the nerve, therefore decompressing the area and reducing symptoms. My experience with this is limited.
Since performing sclerosing injections, I have greatly eliminated the need for my patients to have surgery. If my patients didn't have success with the injections, I wouldn't be performing these injections. These injections have allowed many of my patients to avoid surgery, therefore allowing them to function immediately with no need to take time off for surgery.
Educate yourself, trust your doctor and make the decision you are the most comfortable with at the time.
Re: neuroma treatmentDr. Z on 2/15/03 at 17:56 (109308)
Ia agree with Dr. Wander. I have used local alcholic injections for over five years it is an excellent treatment with very good pain re that solution has stood the test of time.
Re: Question for the docs on neuroma treatmentPeggy on 2/15/03 at 23:37 (109336)
Well I won't respond to her answer either. Because if she lived in a town where your feet take you everywhere, I believe she would have a different view. I live in a big city so walking isn't an option -- it's mandatory MOST of the time! And like the docs said here, I've had some success and believe in the injections, however, I thought it did kill the nerve; and wish it did. We're not talking about killing people or animals here! But on occasion, I'm still experiencing pain and sick of it! I need to get on with my life already. I am wearing Danskos -- thank god for those shoes; and can walk more now; but if I just jerk my foot wrong, the neuroma bothers me -- like a muscle spasm. My question for the docs are; does this nerve actually heal after awhile? Does heat or cold help; I soak in epsom salts. And I have moleskin padding on my feet too -- which help but such a pain to cut them into shape all the time and after a day or two, they lose it's stickiness and I have to tape them.
But I am not sure if I should consider sclerosing again. I've had a series of 5, however, my podiatrist indicated that sometimes the first two aren't effective. I don't want to overdue it but would be interested to know from some of the docs here if I should start them again.
Also, the first podiatrist I went to had given me the moleskin pads already cut into shape that were on a type of waxed paper. I'm wondering where I can purchase them as I've never seen them in any drugstores; they are already in that shape. Perhaps a medical supply store(?)
Re: Question for the docs on neuroma treatmentDr. Z on 2/15/03 at 23:49 (109338)
You can start the series again . You can go to seven or you can increase the amount of injection. I have used three cc's of solution in one area . Sometimes the concentration can be increased however I prefer increaseing the amount of solution A moleskin pad is too thin , you need a pre-cut metatarsal padding. Sometimes the neuroma pain will return but most of the time once its gone it won't come back. Sometimes surgeyr may be needed . So there you go
Re: Question for the docs on neuroma treatmentSuzanneK on 2/15/03 at 23:58 (109339)
Peggy, I am not a doctor, but I did have the sclerosing injections for treatment of a neuroma. It took 9 injections for me to get relief. My doctor (podiatrist) starts with a series of 7. We waited 2 months, and then I went back for a series of 2 more. There is still a slight sensation at times, but overall, I am very satisfied. My doctor says he has noticed that it takes a minimum of 7 injections for a 'success.'