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Sunday, March 18, 2018

Oral Cortisone for Nerve Pain with Inflammation

Dear Dr. Blake
I wonder if you would be able to answer a quick question for me?  I'm here in the UK and have been suffering from neuromas in my feet (2 in each foot) for around 17-years.  The right foot was operated on in 2012 and now I have 2 stump neuromas (both >1cm).  The neuromas in the LT foot are also >1cm.

In an attempt to avoid further surgery I have had radiofrequency ablation, cryosurgery, alcohol injections, steroid injections etc.  None of which have really worked that well, though the steroids do help a bit.  The surgeon I have been seeing is reluctant to offer any more steroid injections because he is concerned about foot pad atrophy (he is not the surgeon who operated on the RT foot). 

My neuromas are causing me a lot of problems at the moment, though I can still cycle (which is a great passion of mine).  Later this year I plan to ride from Moscow to London, then at the end of the year, proceed with surgery.

My question is whether you think a course of oral prednisolone might be worth a try, just to get me through this exacerbation of symptoms/

Thanks so much for your help
Kind regards

Dr. Blake's comment: A 6 to 8-day course of oral cortisone to drive down inflammation is okay. Remember no strenuous activity for the duration of the meds and another equal time, including cycling! It can only be done once every 6 months! Rich

Two good articles:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737790/

This article above is great in cautioning it not to be used in skeletally immature athletes and limiting the total dose under 400 mg. But, there is no mention of not exercising while on it or for the next 6-8 days. This helps prevent bone problems like osteonecrosis, stress fractures, etc. From what I have read, these tips are anecdotal but an important precaution. One rheumatologist believes that any form of cortisone should be limited to once per month, with oral once per 6 months. The article below talks about the prednisone burst dosage and how wired people feel the first 4 of 8 days. Rich

http://www.drblakeshealingsole.com/2010/12/oral-cortisone-king-of-anti.html

This I wrote this article 8 years ago, I would add not to be used if you have Vit D deficiency or Low Bone Density, or any problems that cortisone may affect (slight Adrenal Insufficiency). 

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.