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Monday, July 30, 2012

Morton's Neuroma: Email Advice for a Seasoned Runner

Dr. Blake,

Since moving to San Francisco 5 years ago I have seen you for new orthotics, corns, and 1 yr ago had you make me slimmer orthotics for my
racing shoes, all because I was dealing with a chronic hamstring issue.  I was able to race while managing the hamstring but this Spring took a little time off
and had ART on the hamstring.  Glad to say it is finally resolved. 
Dr Blake's comment: ART stands for Active Release Technique and it is wonderful for plantar fasciitis. I have limited experience for injuries above the knee. 

 During the treatment, sciatica involvement was mentioned but since it resolved gave it
little thought.  Not sure hamstring/sciatica is involved with Morton's Neuroma, but once I returned to running (50-55 miles per week) I started to feel a burning sensation on the ball of my foot same side as hamstring and/or sciatica issues. 
Dr Blake's comment: I remember one of those angry letters I got early in practice 25 plus years ago. It was from Ann (real name since docs remember their failures more than their successes). I had treated her for hamstring strain for 3 months with only slight improvement. Then, another doc diagnosed sciatica as the cause of her hamstring tightness and soreness. I guess it came from her back, but I never saw the completion of treatment. But, I remember making this permanent correlation to foot nerve symptoms to possible back involvement.
 Over a 2-week period it got worse.  Always worse at the beginning of a run, then subsided but soon after realized my toes were actually feeling more numb.
2 weeks ago in an attempt to stay local in Novato (thirty miles from Dr Blake's office) had it diagnosed as Morton's Neuroma, (x-ray taken was unremarkable) and sent away for a week with a metatarsal pad placed on my foot  - my options were cortisone shots, a series of alcohol injections and if they failed surgery.
Dr Blake's comment: Yes, these are 3 options in the treatment of Morton's Neuromas, but far from a complete list of treatments. 
In the meantime I did some research and asked around in the running field and quickly learned some of the treatment options for example, the importance of proper placement of the pads and frequent icing.  Since reading your very helpful blog I am icing for 10 mins 3x day.  When I returned on Wed the advice was cortisone as the neuroma was described as being large.
Dr Blake's comment: Please read my post on the Theory on Cortisone Shots below.

 I took the shot and continued pool running until today (Sat).  I had little pain running but  resumed at a lesser intensity as the day went on.  I am wondering what your advice would be at this stage of the process.  Should I keep running, can I expect further improvement with the cortisone treatment if I am still feeling some pain?? 
Dr Blake's comment: After reading the post on cortisone shots, you can see that you really must wait 2 weeks before you should run, and another 1-2 weeks to see how running feels. So, minimum to see me is 3 weeks after shot. The next steps are to get a better nerve testing with straight leg raising, neural tension testing, and Mulder's sign. An MRI with dye is conclusive from neuromas, but some neuromas actually do not hurt. You definitely, by your history of possible sciatica, could be a double crush victim. That changes everything, and the source of the nerve pain must be treated along with the foot pain. This is normally when I co-treat with a physiatrist or neurologist.
I will make an appt to come see you but wonder if and when I should do so.
Dr Blake's comment: Cindy, tell me a story about your back symptoms. Then, we can go further with this discussion. Hope this helps you. Rich

Thank you in advance,

Cindy (name changed for privacy)

1 comment:

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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.