Morton's neuroma?

[catwoman]

Anyone here have experience with Morton's neuroma?

I've had problems for a while with my left foot. Became so bad in the last month that I saw my PCP on Friday, who concurred with my lay diagnosis: Morton's neuroma. Nerves in my 2nd & 3rd toes have been very inflamed at times, so inflamed I could barely walk while at a convention 2 weeks ago in can barely walk.
My doctor has referred me to an orthopedic surgeon & said treatment is with anti-inflammatory agents; cortisone shots in the nerves; or surgery. I'm hoping anti-inflammatory drugs provide relief; I'm wary of cortisone shots (hematomas & other side effects).
I'm not courting surgery -- I had bilateral bunionectomy 26 years ago and that was as much fun as OHS.

My PCP said to stress to the orthopedic doc that I'm on warfarin because of a mechanical valve. The orthoped offices in the same small building as my cardiologist -- only those 2 practices in the building -- so in theory they should be able to communicate fairly easily. He stressed that I am NOT to go off warfarin for any reason unless I am on a heparin drip (in hospital) or using Lovenox. Said some patients taking warfarin (i.e., for a DVT or some other situations) can possibly go off warfarin without endangering themselves, but not someone with a mechanical valve, particularly in the mitral position.

My PCP suggested taking Alleve for the pain & inflammation.
Any thoughts/experience with Rxes for inflammation?

 

[bvdr]

Marsha, Morton's neuroma was one of the differential diagnosisis for the neuropathy in my right foot but it was ruled out because it goes up to my knee.
The anti-inflammatory that I get put on at times is Celebrex since it is less likely to cause GI bleeding. I hope you can avoid surgery if possible. I had ankle surgery many years ago and I remember how long it took to get over it.

 

[jeffp]

Marsha,
I won't preface this by saying "I'm not a doctor but..." so I won't. I've been doing foot and ankle surgery for the past 23 years and usually saw 2-3 neuromas per week. Maybe 100 of those over all the years needed surgery - those that did were HUGE. Very few of all the neuromas responded to oral medications. Most often the symptoms were in the forefoot area between the 3rd and 4th metatarsals, and were reduced by taking off the shoe and massaging the foot. An MRI will show them up nicely, though expensively. A low energy (low KVp) Xray does a fair job and is much cheaper.
Now for the words of caution... Orthopods work primarily (99%) on bone and spend little time with feet (not worth the time and effort vs payoff in comparison to the hips, knees and backs). Their Xray techniques also are adjusted to concentrate on bone - all the fleshy stuff you want to see disappears). Find someone who does a boatload of neuromas (podiatrist - find one who does not concentrate on routine care, you'll want someone who does lots of these).
I'd advise trying in this order: oral meds (don't waste more that 2 weeks with these), orthotics (custom shoe inserts that reposition the pressure pattern. yes, they work well, believe it or not!), cortisone injections, nerve sclerosing injections (this was where I found the most got relief), wait a while (like many nonfatal things - sometimes they just give up and go away), surgery. There's no reason to be un anticoagulated for this type of surgery as the usual blood loss is less that a teaspoon, and even that's considered messy. Since beginning taking the stuff, I've given about a dozen or so lectures on warafrin use in foot surgical cases and could only come up with a few cases where I could envision bridging therapy. Good luck with it, they can be a real pain.
Sorry for being so long winded.

 

[Marty]

Marsha, At my Kaiser clinic in Falls Church, the only people who do foot surgery are podiatrists like Jeff. I read all their regular x-rays and some CT and MR's. These guys are terrific. They take wonderful care and the patients love them. My advice find a good podiatrist, one who is well trained and does a lot of surgery if you decide to go that wayAll the warfarin patients are managed by our two Ph.D pharmacists usually with a Lovenox bridge if indicated though as Jeff says this may not be necessary. The foot surgery is done in and out surgicenter with excellent anesthesia and recovery. I've never heard of any trouble with this system.Yes I had a neuroma 30 years ago. Cured by orthotics. Marty

 

[catwoman]

Jeff & Marty:

Thank you very much for both of your excellent posts. I think I'll call my PCP's office Wednesday & ask for a referral to several podiatrists & find one who has treated a lot of neuromas.
I talked with a friend yesterday, an RN who works at a hosital, and she had a neuroma that required surgery. Had tried meds, cortisone shots, finally had surgery. Podiatrist did it. Said recovery was very easy, surgery done from top of the foot rather than from bottom of foot (I've already web-searched about neuroma surgery).
I can't imagine why there would be a lot of blood loss from the surgery.

 

[catwoman]

Jeff:

I have an appointment next Tuesday with a podiatrist (referral from my PCP). The person who set up the appointment swears the heart valve/warfarin situation won't be a problem. We'll see....

I'll certainly be armed with info from this website.

 

[William]

Wishing you the best on that, Marsha! I too suffer from some kind of foot problem that's been going on for around 7 months. At first it seemed like Morton's Neuroma, but I had some tests done a few weeks ago to see if there's something more going on. I'll see the Doc Friday to find out the results. Do you think there's any connect between our situation and a heart problem? Will

 

[catwoman]

Wishing you the best on that, Marsha! I too suffer from some kind of foot problem that's been going on for around 7 months. At first it seemed like Morton's Neuroma, but I had some tests done a few weeks ago to see if there's something more going on. I'll see the Doc Friday to find out the results. Do you think there's any connect between our situation and a heart problem? Will

I doubt it. I know lots of folks with foot problems -- neuromas, bunions, spurs, etc. -- who don't have heart problems.
We just drew the black bean on two accounts.
Please let me know what the test results are.

 

[RCB]

Thank you Catwoman!

Thank you Catwoman!

For thirty-five years I have suffered with foot pain. In that time I have seen
all kinds of drs. and other healthcare providers and no one suggested a name for what I have. In 1991 a new podiatrist used ultrasound on my foot, but never suggested a name. He did get me in to orthotics, which did seem to control to pain most of the time. If I wear a pair of shoes that I can't wear orthoicts with, I have pain in a matter of hours. I was told Medicare won't pay for orthotics, because they feel they won't work. Now I know what name to tell the stupid drs, so maybe I'll get the right treatment. I'll be following your surgery to seriously consider it for myself- I have suffered too long!

Good Luck and thanks for posting this.

 

[lance]

neuroma treatment

neuroma treatment

Good morning Catwoman

It looks like I have a Morton's Neuroma too so I have been Googling for information for treatment. Up popped your thread from several years ago. Small small world or valvereplacement has a huge part in it.

Hopefully you've found relief from the pain. What treatment did you decide upon? I've been struggling with this for nearly two years. I hope relief is in site soon

 

[catwoman]

Luckily, miy problem went away on its own. So I'm not sure exactly what I had. If you've been dealing with Morton's neuroma for 2 years, you'd better get it taken care of and get some relief.

However, I now have a synovial cyst on a toe on my right foot. I asked my PCP about it Thursday during my annual physical, and he's referred me to a podiatrist.
He said he could do a needle extraction in his office, but it would probably come back. He said it will have to be removed to avoid its return. I've already googled about synovial cysts and am not looking forward to this adventure. I am already anticipating the usual hold-warfarin order.

 

[ChouDoufu]

owies, i got one too. i'd love to try out this new cryosurgery

http://www.youtube.com/watch?v=9fqalM4EjVE

but no place nearby (in southeast asia) that i can locate.

may go in for traditional excision this summer.

 

[catwoman]

ChouDoufu:

Very interesting..........

 

[Guest]

Anyone here have experience with Morton's neuroma?

Me, I had surgery back in 1993, two cortisone shots prior but they did not help enough. My right foot, all the running I did contributed to it. I have one in my left foot but it has never bothered me to a great extent to do anything about it.

I've had problems for a while with my left foot. Became so bad in the last month that I saw my PCP on Friday, who concurred with my lay diagnosis: Morton's neuroma. Nerves in my 2nd & 3rd toes have been very inflamed at times, so inflamed I could barely walk while at a convention 2 weeks ago in can barely walk.

Could be degenerative arthritis in your toe joints. My right big toe is altering my foot strike because of limited motion in my toe. Who would have thought a big toe could cause so much discomfort. My entire foot had become painful. I have had pain behind my second and third toes also.


My doctor has referred me to an orthopedic surgeon & said treatment is with anti-inflammatory agents; cortisone shots in the nerves; or surgery. I'm hoping anti-inflammatory drugs provide relief; I'm wary of cortisone shots (hematomas & other side effects). I'm not courting surgery -- I had bilateral bunionectomy 26 years ago and that was as much fun as OHS.

A podiatrist can do the surgery, outpatient, through the top of your foot.

My PCP suggested taking Alleve for the pain & inflammation.
Any thoughts/experience with Rxes for inflammation?

Advil works for the pain and inflammation, you have to be careful though because of coumadin.

Now the nitty gritty, I have moderate arthritis in my right foot big toe. I'm seeing a podiatrist here in Austin, last Monday, I recieved a cortisone shot into the toe joint. The pain from the shot when the numbing agent wore off was excrutiating. Worse than my OHS pain. Nothing took the pain away, 2 advils, 2 extra strength tylenol, and 1 narcotic pain killer in 3 hours. I slept very little that first night, went to work the next day 1/2 day, could barely stand a shoe on my foot, came home and took 1 narcotic pain killer and slept for 3 hours. Ice helped with the pain also, and ice makes the cortisone work better. My foot did not feel better enough to walk comfortably until Thursday.

My neuroma spot is acting up again too. Could be because of my altered foot strike and the big toe. I get nerve pain into my 3rd and 4th toes with radiation up the top of my foot to my ankle. He said that sometimes the nerve will re-grow fibers and that may be what's happened to me. Hey, 16 years pain free from the first surgery is a good time frame for me.

The podiatrist injected cortisone and an alcohol something or other into that spot. The nerve has settled down. He said 3 to 6 shots for that spot, and it essentially kills the nerve so that I don't have to have surgery again.

The recovery from neuroma surgery is about 3 to 4 weeks, you have to elevate your foot when sitting because it will swell, also they may have you have sonogram treatments afterward to help healing. You'll have to soak your foot and do some foot exercises for the ligaments in your toes post op. I used a wheelchair to shop at the mall (the ones they have there for handicap folks) because it was difficult to walk for long period of time the first couple of weeks. Overall, if all else fails, the surgery should help you. You may ask though about the alcohol treatment to kill the nerve if you don't want surgery.

Oh, I bruised some from the shots last week but nothing extensive. I was out pushing the lawnmower today and doing yard cleanup all weekend.

The podiatrist I saw in Lewsiville was Michael Metzger, my podiatrist here in Austin knows him, small world. I'm not sure if he's still in Lewisville but you could try googling him or look him up on superpages.com

 

[lance]

Thanks Louise and Catwoman

Cat I'm happy your pain went away.
Had orthotics made last spring. It worked fine for a week or two. Ayt the follow-up appointment he told me there was nothing more he could do. So that was that and I didn't order the second pair of orthotics. Anyway by December the pain was so bad something had to be done so I saw my PCP and I'm waiting for an appointment with a specialist.

Louise and jeffp
That's the best explanation for Morton's neuroma surgery and recovery I've encountered. Thanks again
Cheers