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Sunday, April 21, 2013

Morton's Neuroma: Email Advice

This pain is so extreme that it makes me cry sometimes. I am a very busy person, I work full time in an office setting, in a high demand management position, I can't sit 40 hours per week, I'm usually on my feet about 1/4 of the day. 

I have been diagnosed with Mortons Neuroma I guess in both feet.  Previously my Podiatrist told me that the pain I have been experiencing was "Inflammation in the Joint" but not arthritis. Now I have had a few cortisone shots, probably a few per year, and I also wear custom orthotics, the kind that are hard and plastic, they don't bend.  I have no idea what amount of cortisone shot I am getting, but they are always painful. The shots seem to help a little at first, but wondering what I should do? He said if the pain keeps up he is going to suggest I look into the option of surgery, and I'm scared of surgery and all the down time. My husband is currently not making that much money, he is searching for better paying work, but I am the main breadwinner of the family, and I can't imagine how I will do my job and be off work to heal from foot surgery on both feet.

Can you tell me something simple I can do? I am also trying acupuncture, and looking into other things I can do for the nerve pain. I own a TENS unit, and I am brave enough to try it on my feet. It might work. I usually just use the TENS unit on my back. I broke my tailbone years ago and suffer from chronic pain. 

Please help. Any advice is appreciate. 


Dr Blake's comment: 

     Thank you so very much for your email. Below are 2 links to general blog posts on Morton Neuroma care.

You need to calm the area down. Of course, it is much harder since it is on both sides. Sometimes, even though there is more pain on one foot, I will treat the less painful side for awhile and hope the other side does not get worse. See if you can try a removable boot (like the Anklizer with an EvenUp) for the 25% of the day you are on your feet. You first have to see if it helps you. If it does, alternate days between the right and the left side. If that helps, you have be helped with more traditional shoes that either rock n roll or are stiff across that area of your foot. You can try hiking boots or the New Balance 928. Even the Hoka shoe line has helped some patients get through the day. As you look for foot wear to mechanically help, begin using a reusuable ice pack to cool down the area three times a day, whether it hurts or not. The ice pack can be placed on the ground with both feet on top. Do 10 minutes three times daily. If the ice is wonderful for your symptoms more cortisone shots are indicated. If not, you still may be a candidate for the 6% alcohol shots. Remember, shots are meant to get you by in your scenario. Delay the need for surgery for awhile until time is right financially in your case. However, many many many patients with shots (cortisone or alcohol) have never needed surgery. But, I would go into the shot world with the initial expectation of just delaying the inevitable. Alcohol shots definitely work better when contrast MRIs show no neuroma, but they can help no matter what the MRI says. 

 Nerve Pain is local to the foot and systemic to the whole body. Your treatment should reflect that. Locally, you calm the nerve down with moist heat, icing and/or contrasts (finding out what seems to work the best), topical NeuroEze or compounding creams/gels, finding out whether you should get another cortisone shot based on dosage (typically 30 mg of long acting cortisone per year in any one area is maximum), alcohol shots,  adjusting the orthotic devices for more metatarsal padding to spread the metatarsal apart to let the nerve through and off weight the sore area, accommodative padding to completely off weight the area, looking into all types of shoes for work that seem to be the right cushion, stiffness, openness to avoid compression of the nerve, stability and heel lift (you may be surprised what shoe feels the best), acupuncture or physical therapy, TENS, and chiropractic.
Nerve pain is the worse pain to have. Nerves run along a superhighway right to the brain. Patients with nerve pain that involve the brain's interpretation tend to have more pain than they should. Many times, even when the nerve pain is local, when patients report pain levels of 7 to 10, a systemic approach must be taken. This typically involves medications to de-sensitize the pain including gabapentin, lyrica, cymbalta, nortriptyline, etc. This typically takes a pain specialist, working with the podiatrist or orthopedist, to get the pain level to the more acceptable 0-2 range. 

I sure hope this helps you in some way. I am sorry for the delay. I was off on vacation, and rest was much needed for my soul. 

Pre Sunset looking over the piers in Oahu's Hilton Hawaiian Village


1 comment:

  1. I used TENS Unit against the pain of my knees. I must say that it helps me but only for a short period of time. I don’t know how often I must use it. Is it healthy to use it day by day or only twice a week? Thank you.


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.