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Wednesday, January 1, 2014

Morton's Neuroma: Successful Surgery after conservative therapy failed

This was a wonderful comment to my post below on Morton's Neuromas and their Treatment Options. Thank you to the young man who wrote this. It does not change my mind on being conservative, but I do not think his first 2 podiatrists gave him an option of surgery. I do not do surgery, but we have 2 highly trained surgeons in the office who I consult frequently. If you have a solid diagnosis of Morton's Neuroma, you must be informed of your options, for it is the only way to make the best decision for you. You are the one feeling the pain, the doctors can not, but the doctors should help you stay objective and help you work through the treatment.

I had MN in my right foot. I visited three podiatrists before finding one who was willing to perform the surgery - and he changed my life by doing so. I had orthotics, splints, injections - everything - over a 12 month period. Nothing helped and I woke one day wanting to cut off my foot (seriously, that is what I told my wife).

After changing from a PPO to Kaiser, I once again visited the Podiatrist. The doctor immediately said, "If you've tried other remedies, then you need surgery." I had the surgery two weeks later, and was walking with a padded covering the next day. The difference almost brought tears to my eyes.

I know of two others (also runners) who have had MN and the only remedy was surgery. The podiatrists I fired were all unable to perform the surgery, so they tried to offer every remedy under the sun except the only one that would help. Makes me angry even typing this.

I now have MN in my other foot (presumably years of running and years of marching are taking their toll). I see my doctor next week and I am quite certain that he will go back and pull the nerve. IT IS THE ONLY TRUE REMEDY IF YOU ARE IN PAIN.

Dr. Blake - saying that only 5% require surgery simply cannot be true and is certainly misleading to the patients seeking comfort in a very painful foot. I fear that they will follow the guidance and try to seek comfort with other treatments for at least one year (as you suggest) like I did. For the third of sufferers who have the pain in their foot, especially at the 8-10 on the pain scale, they will not be cured with orthotics, therapy, injections, etc. Surgery is their only cure.

Dr Blake's Response:
Thank you so very much for your heart felt comment. Most of my patients who have surgery for Morton's Neuroma feel the same way. When you need surgery for Morton's Neuroma, you should have it. This does not however mean that conservative treatments should not be tried before. 

There is typically a 3 month window of time after the patient first presents with MN pain that 2 things happen: A) an attempt at conservative treatment is initiated, and B) MRI documentation along with an evaluation of other causes of nerve pain. If by the end of the first 3 months, the conservative treatment is not working well, the MRI documents a MN, and other forms of nerve pain (like low back referred pain are ruled out), surgery is recommended. 

The gray areas come from patients where the pain is manageable, the MRIs are inconclusive, and there is some suggestion of low back involvement. 

So, I am very happy for you. I am biased to avoid surgery when possible, and that bias does come across strongly. I always feel bad when the patient and I work hard together to avoid surgery, but in the end surgery is needed. But, my patients know that if conservative treatment fails, surgery is our last resort option. How does conservative treatment fail? One way is that the pain level is not managed in the 0-2 range (Good Pain). During the first few months, while conservative treatment is being explored, it is imperative to do whatever to get the pain under control. This is more true for nerves than any other structure. Dr Rich Blake

1 comment:

  1. I believe that people with morton's neuroma should not ignore pain because the earlier they are diagnosed, the more likely that Morton’s neuroma can be successfully treated without surgery.


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.