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Latest treatment for Neuromas?

Posted by Kewiston on 4/18/04 at 23:16 (149110)

What are the best and/or latest treatment for neuromas?

Re: Latest treatment for Neuromas?

Dr. David S. Wander on 4/19/04 at 17:16 (149150)

The most recent/latest treatment options for a neuroma include:

1) Metatarsal pads
2) Anti-inflammatories
3) Change of shoes
4) Orthoses
5) Ice/rest
6) Cortisone injections (up to 3/year)
7) Sclerosing alcohol injections ( a series of 3-8 injections)
8) Traditional 'open' surgery to excise the neuroma
9) Endoscopic release of the transverse metatarsal ligament (the EDN procedure)
10) Surgical release of the transverse metatarsal ligament through a small incision between the toes using the ISOGUARD system/instrumentation.

All the above treatments have some levels of success and some failures. Obviously, conservative care should always be attempted prior to surgical intervention. If conservative measures have been exhausted and surgery is the next step, you may want to first consider sclerosing injections, which may provide significant relief. Discuss these options with your doctor.

Re: Latest treatment for Neuromas?

Ed Davis, DPM on 4/19/04 at 23:50 (149179)

David:
I think you have a complete list. What is your experience and/or opinion on alternatives #9 and #10 compared to #8 as this has been a subject of discussion on the surgery board?
Ed

Re: Latest treatment for Neuromas?

Rose on 4/20/04 at 20:03 (149249)

After battling the neuroma for a long long time and seeing a chiropractor, a podiatrist, trying accupuncture, all three of them agreed that the neuroma does not go away. I did all the traditional more conservatice treatments too.
I had the surgery for it and it was completely healed in less than 6 weeks. Now Plantar fasciitis is different. It seems to repsond to the various treatments for various people sometimes.I had very painful PF in the other foot and had surgery for that at the same time. It has been 9 months and the PF is still healing. I expect it to be gone completely by a year. But I still am doing physical therapy for it and it may still not completely go away as far as the pain goes. I do not take any medication and just have to not be on my feet for too long. The neuroma has been healed for months and months, unlike the PF resease.
But, I do think that possibly the best solution for a very painful neuroma is simply to have the surgery if all other methods have failed. It is very quick to heal as compared to the PF surgery. There are various types. There is removal of the neuroma, cutting the tendons and opening it up... (that is what I had) and a newer procedure, which was invented by my doctor, where the nerve is rerouted around the foot into the arch someway. I have talked to people who have had all three, and they have all been pleased. Now, it does grow back sometimes, but the pain is completely gone, you can walk after the surgery ever so carefully, and it heals quickly. I know a jazzercise teacher in her 50's who had the neuroma surgery on both feet at the same time and is back teaching many high impact classes already with no pain at all. It does heal very quickly.

Re: Latest treatment for Neuromas?

Ed Davis,DPM on 4/21/04 at 00:33 (149265)

Rose:
I have to agree with you 100%. Surgery for PF has a mediocre success rate and a potentially long recovery. Surgery for a Morton's neuroma hasa high success rate and generally a rapid recovery.
Ed

Re: Latest treatment for Neuromas?

Dr. Z on 4/22/04 at 21:11 (149378)

I have had some very high sucess rate3 with excision of a neuroma,however I have seen some very serious complications with an excision and this is why we need to continue to look for better and safer procedure. Only time will tell if the ligament release is one of them. I do feel that the alcohol injection procedure is an excellent first line treatment for neuroma pain.