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Neuroma

Posted by Sue R. on 2/20/03 at 14:40 (110068)

I have a neuroma in my right foot and have had cortizone injections which have not helped. I went to another DR. and had a bone scan he said I had a fracture and I wore a boot that went to my knee for 8 weeks, it is still no better. I went back to the first Dr. and he said my only answer is surgery, but he is booked for 6 weeks and then he said there is a possiblity that the neuroma can come back. Please Help, I am scared to death, but I can't stand this pain. I saw the surgery where the ligament is cut and would like to have that done, but can't find anyone in Ohio that does it. Would you know where I could go in Ohio to have that done?

Re: Neuroma

Dr. Z on 2/20/03 at 17:12 (110101)

Hi,

Search the heelspurs.com for the following topic called alcholic scerotic injections. This is where diluted solutions of lidocaine with alcohol is used to stop the pain receptors in that damaged nerve from transmitting pain. This is very effective and is now one the main treatments for chronic neroma pain before surgery. The alcohol injections can be given in more then one interspace. There are not complications that can occur with surgery.
Now let's talk about the ligament cutting procedure. This can work however when you cut the ligament you can have the adjacent metatarsal bones dislocate and cause more pain and additional surgery. I would go for the scerotic injections before any though of neuroma surgery.

Feel free to ask any questions you may have

Re: Neuroma

Dr. A on 2/20/03 at 22:11 (110151)

you can find more info on intermetatarsal ligament release on podiatryinfo.com. I have performed this procedure in my office under local anesthesia and recommend this to all my patients before excising the nerve. I'm in St. Louis, but I'm from Ohio originally and I'm sure you can find someone in cleveland or columbus who have experience with this procedure if you ask around.

Re: Neuroma

Dr. David S. Wander on 2/21/03 at 16:25 (110205)

I'm a little confused regarding your diagnosis. One doctor said you have a neuroma, and another doctor had a bone scan performed and said you had a fracture. After immobilization, you are continuing to have pain. Has the coctor that diagnosed the fracture done follow up x-rays to see if the fracture is healing? Does the 'other' doctor feel that you had a fracture AND a neuroma?

If there is a question regarding a neuroma vs. other problems, a gadolinium MRI or a diagnostic ultrasound should be very helpful. But first I need to know whether the doctors think you have a neuroma and a fracture, and whether there were follow up films for the fracture.

I agree with Dr. Z, that sclerosing injections are preferred over any type of surgery, whether it is a release of the transverse metatarsal ligament or removal of the 'neuroma'. But first I'd make sure that a neuroma exists. There is an EXCELLENT podiatrist that I believe practices in Euclid Ohio and North Olmsted (I don't know how close that is to where you live). His name is Dr. Gerard Yu and I would highly recommend that you contact him if it is convenient.

Re: Neuroma

Dr. A on 2/21/03 at 22:34 (110269)

percutaneous transverse metatarsal ligament release takes 15 minutes to perform in the office, one suture is removed in 1 week and tennis shoes can be worn in 2 weeks. The results are consistently good and my patients are very satisfied with the outcomes. I do not have a lot of experience with sclerosing alcohol injections. Do you mind sharing your protocol?

Re: Re Percutandous desmodectomy ( ??)

Dr. Z on 2/22/03 at 09:39 (110298)

It is weekly local injections of 4% alcohol injections placed directly into the neuroma if possible. Takes somestime up to seven. I will sometime increase the amount of solution up to 3 cc per injection depending on the response.
When you do the percutaneous desmodectomy how to do you it.? Is this the EPF version or is this where you actually just take a small #63 or #67
blade and cut the ligament. If I remember this percutaneous procedure was first performed in the late 1960s early 1970's. I saw this percutaneous procedure done by a Dr. Edwin Probber at that time. I believe he was the first to ever to do this mininial incision surgery . He called it a desmodectomy. I may have the spelling wrong. I will have to ask him about it

Re: Re Percutandous desmodectomy ( ??)

Dr. David S. Wander on 2/22/03 at 16:22 (110401)

Dr. A,

There's an excellent article by Dr. Gary Dockery that was published in the Journal of Foot & Ankle Surgery detailing his protocol and study results. As per Dr. Z, the injections are a 4% solution which is made up of 0.5% Marcaine with epi (unless contraindicated) and absolute alcohol. A 50 cc vial of Marcaine is used and 2.0 cc's are drawn out and discarded. Two ampules of absolute alcohol (each is 1.0 cc) are then injected into the Marcaine, therefore making a 4% solution. The injections recommneded are 0.5 cc injected every 10 days directly into the neuroma, with a minimum of 3 injections and maximum of 7 injections. If you can't locate the article, email me your fax and I'll send it over to you. (email removed)

Re: Re Percutandous desmodectomy ( ??)

Dr. Z on 2/23/03 at 15:32 (110527)

I started with this orginal article but switched back to he lidocaine mixture. I found that maricaine with EPI was very painful. Just have to use more amounts of lidoicaine plain then with Maricaine at times

Re: Re Percutandous desmodectomy ( ??)

Dr. A on 2/23/03 at 23:40 (110571)

thanks for the info. I use a MIS 64 blade by feel with no endoscopy equiptment. The reason I have not used alcohol injections in the past has to do with the duration of treatment. Maybe it is just my patients, but they are not thrilled about coming back once a week for 7 weeks for injections. They usually lean toward a more definite treatment that will let them get on with their busy lives. I will attempt to recommend alcohol injections in the near future as an alternative. I treated 5 or 6 patients with alcohol injections in the past and found that about 1/2 the patients were happy with results, that is why I deviated away from them. Maybe there is a learning curve.

Re: Neuroma

Amber on 4/01/03 at 15:34 (115105)

Hi,

Could someone recommend an excellent doctor for neuroma in the New York City area? I've been treated by one podiatrist but haven't been all that happy with him. A doctor who practices sclerosing injections on a weekly basis. And also one that will give me a gait analysis. Thanks