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Wednesday, May 3, 2017

Morton's Neuroma: Email Advice


     Today I was diagnosed by my orthopedic doctor with morton neuroma, after initially being diagnose with sesamoiditis from my sports medicine doctor. He noted that while there is some inflammation in the sesamoids, in my MRI, my symptoms do not correlate with sesamoiditis and definitely don't warrant 6-8 weeks of an aircast boot & NWB. He also said even though my MRI didn't exactly show a morton neuroma, he said the nerves are hard to show up on MRI.
Dr Blake's comment: This is very true at times. You can have Morton's nerve pain that hurts like a neuroma. The irritated nerve does not show up on an MRI. You are supposed to get contrasts to rule out a neuroma in an MRI, so the MRI if done without contrasts may have to be repeated down the line. Hopefully not!!

     I don't have the big toe pain, he thoroughly examined my foot, where the pain is near the middle of the top of my foot, feels like I have something under my foot when I put pressure on it.
Dr Blake's comment: It would be helpful if you sent a photo with you pointing to the area. but it is not where you get sesamoiditis. 

     I have burning stinging pain in the ball of my foot, with off and on toe cramping. Which is all why he came to the diagnose of morton neuroma. He recommended cortisone pills for 5 days, to begin slowly walking again after 3 weeks of inactivity and good supportive shoes with wide toe box as well as custom orthotics. He said if after a a week my pain doesn't lessen, he recommends cortisone shots, which I've heard horror stories and am scared to get. What are your thoughts, is it possible to have MN and not have it show up on an mri ? 
Dr Blake's comment: It all sounds right, but a little rushed. Could you use 600 mg ibuprofen three times a day for 10 days? During this time add daily ice pack to the bottom of your foot for 15 minutes twice daily. Then you could avoid the cortisone pills for now. Try a small longitudinal Hapad arch pad as a metatarsal arch instead of initially going to orthos. I have plenty of photos in my Morton's Neuroma posts. And, yes, you can have the symptoms of a neuroma, without the findings on MRI, and without MRI evidence of a neuroma, surgery is probably not warranted unless you are a rare case. The cortisone shots can be irritative, but horror they are not. I have no problem giving an occasional cortisone shot, and usually the patients are happy. Read also my posting on Double Crush, in case the nerve is referred. 

Also are orthotics worth it, or can I use the metatarsal pads to offset weight on the MN? I've heard success stories of the alcohol injections, is there any good doctors in the Denver area?  I would sincerely appreciate a response, though I know you are extremely busy. 
Dr Blake's comment: Try Dr William O'Halloran in Denver. Great guy. Yes, off weight with Hapad first. Do a diagnostic local anesthetic shot first to see if they can find the right nerve to inject. Good luck!!


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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.