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Tuesday, May 1, 2018

Nerve Pain flared with Removable Boot

Dr. Blake,
I have been following your blog for years and have a question about neuromas. Mine was under control for 5 years (with custom orthotics, met pad, wide shoes) until I was in a boot for PTT on the other foot and it flared. Since then I've not been able to get ahead of the irritation/inflammation cycle. Twice I've irritated it to a new level, most recently trying acupuncture. Before the acupuncture, I could wear Birkenstocks in the house without symptoms but now even standing for a short time will bring on symptoms and only elevating my foot keeps the symptoms away. Shoes, tight socks, sleeping (I now wear a Birkenstock at night), driving especially, all irritate it. I have had two cortisone shots which didn't help (I was told at least one was not long-acting).  

My question is at this point even if I was to do nothing that irritates it ( which I guess would mean keeping it up all the time), would the scar tissue around the nerve decrease in size? Also, does Neuro Eze work to shrink the nerve or just help with symptoms? At this point, it seems like my only options are some kind of intervention, cortisone, alcohol shots or surgery. What would you do in my position? Thank you so much

Dr. Blake's Response:
     Thanks for the email. It sounds like you irritated the nerve, more than caused inflammation (since the shots should have helped an inflammatory problem). It could have been the unevenness to your spine of the boot that caused a sciatic nerve irritation affecting the foot. I would approach it this way for the next month. 

  1. Neuro-Eze topical three times a day as a non-painful massage
  2. Neural Flossing three times a day.
  3. Experiment on removing the met pad which can irritate an irritated nerve. 
  4. Try contrast baths with 4 minutes warm and 1 minute cold alternating for 20 minutes twice daily
  5. Avoid the bend at the toes with the boot on the neuroma side with orthotics, or a mountain bike shoe with a flat bottom, or a Hoka One One shoe (they have a couple of versions that are wider in the front). 
  6. Avoid barefoot (try Oofos sandals or Halfinger sandals for home)
  7. Avoid shots and acupuncture on the sore foot. Acupuncture on the opposite hand or earlobe can be considered. 
  8. Look into a 2 month trial of Quell. 
  9. Try a scooter to off weight at home and museums if the other side can take the weight. 
  10. Since it appears to be nerve pain, consider seeing a pain specialist for oral intervention (at least an evening dose of Lyrica, etc.).
  11. Create an environment for May of 3-4 level pain, and find out what you can and can not do. 
  12. In June, we will try to increase your activity, and lower the pain to 2-3 consistently. 
  13. You make want someone to really evaluate double crush syndrome, and fully examine your spine (low back to neck). The trigger of the foot pain can be anywhere up the chain, including hamstrings, piriformis, cervical neck discs, etc.)
Hope this helps get you thinking. Rich

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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.