Hi, let's talk about the second most common thing that we see in the practice
called neuromas.
Neuromas are inflamed nerve tissue in between the toes.
Common symptoms include burning in the toes between the second and third toe or between
the third and fourth toes, feeling like you walking on pebble or rock or burning
sensation on the ball of the foot. This can be very debilitating for people
especially if you like to wear high heels or very narrow shoes, this can
cause more aggravation of this tissue.
So let's go on with the 5 secrets of neuromas
that your doctor may not tell you.
Number one -- over 50% of people who have
had neuroma surgery are either other unhappy or
suffer recurrence of neuromas in the foot.
Number 2 -- repeated strong steroid injections
can help -- can help to thin the
fat pad on ball of foot which could be counterproductive to what you want
Number 3 -- physical therapy and orthotic therapy can be successful
for up to 85% of patients.
Number four -- multiple neuromas on the bottom of foot can signify a
compression of the nerve around the -- inside the ankle.
Number 5 -- tight shoes and walking barefoot
tend to be the leading cause of neuromas.
So let's look at point number one.
Over 50% of patients are unhappy with their surgery either due to
recurrence or just continued pain or worsening of pain from surgery.
It doesn't matter how good your surgeon is
unfortunately, this does happen.
Nerve tissue is a live tissue and unfortunately,
no one can predict the recurrence of neuroma surgery.
There is a technique where the surgeon can bury the
stump of the nerve into a muscle or a joint capsule as an additional procedure
to prevent this recurrence but it's not 100% guaranteed.
Number 2 -- the strong injection
unfortunately can cause thinning of the fat pad on the bottom of
foot which is where patients feel most of the pain.
The bottom of foot being right about here.
This is the general area where patients feel pain.
They feel like they're walking on a rock walking on a pebble or feels
like there is something that they're stepping on or a rolled-up sock in the
crest or what we call the sulcus or the bend of the toes
So we definitely don't want this fat pad to go away,
this our body's natural cushion so too many
cortical steroid injections into that area can cause thinning of this fat pad.
Physical therapy modalities can definitely help.
Your podiatrist should order some physical therapy
to see if that will help you out.
Most of our patients actually feel really good with
physical therapy, electrical stimulation,
or ultrasound stimulation to help decrease inflammation of the nerve
Now, tight shoes --
how does that cause that...
let's say you have -- the neuromas are in
between the toes right about here, they run --
they run in between these
bones, the metatarsal. These are the metatarsals, the long bones -- two, three, four, five.
Most common is in this space and this space. So if you can imagine the poor
nerve is -- exaggerating now --
if it grows big, sometimes you actually see the second toe--
second and third toes play a part like this in a patient -- sometimes you see
a person with this that means the neuroma is pretty big. So imagine a big
growth a nerve in between there.
So again, this is an exaggeration but if you wear shoes
that are too tight and narrow can you imagine pressing together from
the side and causing this nerve to be compressed or pushed together, this can
exacerbate symptoms and that's one of the ways we test for neuroma. So when
your doctor squeezes and a nerve pops from the bottom to the top, the doctor
can feel that, that's very indicative of a neuroma deformity as well as
the splaying of the second third toe as an exaggeration here that causes
that is caused by the inflammation of that neuroma
So what do we do conservatively
to avoid this surgical 50% chance of recurrence and continued pain?
Well definitely surgery is not the first line of defense for
for neuromas. Basically we have shock --
high-energy shockwave therapy, we also
have something called radiofrequency ablation that's used for cancer cells
and used for treatment of other benign growth around the body and the nerve
around the neck and the back, now we're using it in the foot.
Basically we stick a probe -- we stick a probe in the orifice after local
anesthesia from top to bottom, we hit the nerve and pretty much it strikes that nerve.
We do it for 90 seconds times -- two times, there's actually a video on that
on the website NeuromaSecrets.com
Again, it's NeuromaSecrets.com
there is a video
about radiofrequency ablation.
Another good option is alcohol injection,
various preparation of alcohol injection have been used for neuromas that can
actually help to ablate or actually shrink the symptomatic neuroma.
It's typically four percent alcohol solution mixed with
another variable solution that your
physician decides to use, that is a series of eight to ten injections
once a week to help to kill the nerve without surgery
again all these options are conservative options for neuromas before
undergoing a surgical excision which has questionable results,
it does not depend
on your surgeon's skill, it is unfortunately one of those surgeries
that does not have a very high success rate regardless of technique so
hopefully this will give you some education about neuromas and if there's any
questions please visit our website at www.NaplesPodiatrist.com
or www.NeuromaSecrets.com
specifically about neuromas.