Re: Morton Neuroma

: Iím a runner who normally runs 4-6 miles 5-6 times a week. Iíve been using orthotics for the past 20 years to correct a pronation problem. I replace them every 3-4 years. I just got a new pair. Iíve developed a Mortonís Neuroma -it's been a problem I've had for several years and have ignored it. My doctor has been treating it with ethanol ejections every two weeks. I have a few questions.

: 1) My foot is swollen and black and blue for the whole two weeks between ejections. It is very difficult to tell if we are making any progress. It is too painful to run on. Is this normal for this kind of treatment?
: 2) Iíve had 5 treatments what is my next choice.
: 3) Iíve been using an elliptical machine to try to maintain my fitness level. Even doing this is painful. Should I continue?
: 4) Is there an expert / specialist in Mortonís Neuroma in the Boston area?

: Any advice would be appreciated.
: Thanks Rob

Personally I don't use ethanol, though some pods do, hopefully with discretion. I prefer long-acting cortisone, usually no more than 2 or 3 injections, it can shrink the fat pad that protects the forefoot. Most neuromas are stubbornly resistant to injection therapy unless you catch them early and identify more primary causes, like tight achilles tendons, or excess pronation (everyone pronates somewhat with every step normally). A nice leather orthotic is helpful-you may need a different orthotic if it got worse just after the new pair was dipensed. I am concerned about the bruising you're experiencing after the shots. You may want to seek out a doctor with experience in cryoablation, or freezing of the neuroma through minimal invasion. Endoscopic release of the ligament that tranversely binds the metatarsal heads has met some success. Ultimately many are removed successfully through an incision on the top of the foot near the toes, although even in the best of hands reoccurrence happens up to 20%.
Also- I would swap the elliptical for a recumbent bike to maintain fitness level.

So your best bet is to begin with conservative non-invasive treatment, and progress to more aggressive based on the results and your symptoms.
Prepare yourself, however,to reduce your miles at least temporarily.

-I practice in the New Haven area-I would ask your MD, your coworkers, your friends for referral to a foot specialist, be they DPM, DO, MD-find someone known for their thorough diagnosis and careful treatment of this painful condition.

Posted By Helpful podiatrist on March 08, 2004 at 20:59:33:

In Reply to: Morton Neuroma posted by Robert on March 08, 2004 at 10:07:32:

Tuli's Double-Ribbed Pro heel cups are the most advancesd shock absorbing heel cups available today. The primary force of the heel strike is absorbed by the larger and higher waffle pattern while the lower and denser waffle pattern absorbs the high pressure and final force spike of heel strike. Perfect for sports activities.

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