Foot docs, Question about a Neuroma

[porsche4life]

Mom has one on her foot. They have tried an insert but that does not seem to be doing much. She is considering having the nerves clipped? Is there any other option? The doc had mentioned a cortisone shot but that seems like a temporary patch....

[dentist90]

Tobra's your man.

[porsche4life]

K, I couldn't remember if it was him, moses, or Noah that was the foot guy...

[R K T]

I've got them in both feet. They are a real pain in the.....
Don't do cortisone, very painful shot, and two of them did nothing for me. I've been to two Drs and wasn't impressed with either one. First one gave me Neurontin. Side effects were pounding headache with hallucinations, chest pain, stomach ache, lower back pain and oh yeah....I didn't take a crap for 5 days! It's also a anti seisure med so if you are taking it for your feet and abruptly stop taking it, it can CAUSE a seisure. This Dr also said if we do surgery, he would cut through the top of my feet and dig down to the bottom to get to the Neuromas.
Second Dr said the opposite. He would cut the bottom of my feet, but recovery could be 6-7 months. He gave me amitriptiline......SAME side effects.
So now, I'm taking tramadol for the pain. Probably have 20 pairs of shoes and the only ones that help are Z-Coils. They are expensive and look really weird, but I don't care what they look like.
Neuroma's won't go away, so someday surgery will be done. Just gotta find a Dr that I trust!

Good Luck.

[Tobra]

dude, WTF happened to your Sooners?

Most commonly between your 3rd and 4th metatarsals, you get this because the nerve gets pinched between the two bones, the ligament that connects them and the ground. Nerve is injured, becomes inflamed and swells, making it more likely to get pinched. Cortisone can shrink it, but will tend to return if you do nothing about mechanical injury to the nerve. I generally give the shot and modify the shoe using a pad that goes behind the metatarsal heads(base of toe, at ball of foot) which serves to spread the met heads apart and reduce the pressure on the nerve.

There are those who do sclerosing injections, you may have heard of this for varicose veins, ethyl alcohol inj. Must burn like a MFer, though I guess you could do an ankle block first. Surgically a few options, with various risks.

1. Cut the ligament connecting the metatarsal heads, either using open or endoscopic technnique. Have not done, but know the guys who developed the endoscopic deal, Barrett and Pignetti(Gomen nasai Takashi san, Pignetti and Barrett). Removes pressure, and the metatarsal heads are still there.

2. Remove the nerve. Numbness between toes, but you don't notice it much, and is preferable to the red hot poker jammed between the toes sensation. Risk of stump neuroma. Never had it happen to one of mine, but fixed a couple. When you cut a nylon or other plastic rope, if you fail to wrap the rope with tape before you cut it, and/or melt the end, it can fray, or get hung up in the scar. Stump neuroma is like a frayed at the end nerve. Tried cortisone, failed, cut nerve farther up, drilled hole in bone, stuck nerve in hole, sewed periosteum closed over it et voila. Idea is that you give the nerve something to do, provide sensation to bone, it is happy and figures out it is done healing. Just drill the bone higher up than you think you need to, tension or pressure on nerve is bad.

Nerve pain is pretty brutal, make you crazy brutal. You can compensate by getting pressure off with an orthotic or walking on your heel, but gait compensation causes other problems. I think I know a foot guy in OKC, probably in the mountains of AZ too Rob, or at least a reasonable drive away.

A pad in the right place and stetching out that tight calf muscle is always a good idea and generally helps. I don't do surgery on them much, because I don't have to, though I do have a redo of one somebody else did that eventually will be happening.