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[smartpig]

My girlfriend has got a bad case of Morton's Neuroma.  She began experiencing foot pain in late November.  She has seen a podiatrist who has given her two cortisone shots so far. These have not helped and Penni has done every configuration of orthotics and pads specific to treating this awful beast!  After reading this great thread on Mountain Projects we are thinking the best course of action is either to do the nerve relocation surgery or the full-on nerve removal:

www.mountainproject.com/v/mortons-neuroma/106909115#a_106939468.

Can anyone recommend a morton's neuroma specialist surgeon in the greater Manchester, NH area?

• We are interested in hearing other folks experiences specific to this problem.

 

• The pros  and cons of full removal vs. relocation of the nerve.

 

• All other therapy short of surgery seems to be a waist of time.

 

• Short of surgery what other long term solutions are out there?

 
She has physical therapy scheduled for February 28th- but she is inclined to cancel that and fire her pediatrist.  She is scheduled to see orthopedic surgeon Dr. Mark Michaud out of NH Orthopedics in Manchester in early March.  Any feedback on him or better doctor recommendations?

[strandman]

Good luck Jamie- the only thing I know about this evil is the PT part. I have a good friend who is a lifer PT/climber and she says it a waste of time for PT.

I seem to think Base had this

[perswig]

No help re:  local doc, but this topic has appeared over at ST a few times.

http://www.supertopo.com/climbers-forum/532230/Climbing-Foot-Pain-Mortons-Neuroma

Good luck to your girl, Jamie.
Dale

[ELM]

I would have her avoid surgery at all costs. PT can go very very long way. Most of all she needs good foot wear....nothing with a heel and something that really supports your foot correctly. Yes a podiatrist can help her but she has to find a good one....inserts can calm the issue until she heals a bit and then good shoes after that will prevent flare-ups.
Surgeons do surgery...see one and ...wow...you need surgery. Avoid surgery for Mortons Neuroma. I have seen severe damage done from "nerve moving" surgery. None have seemed to stand the test of time. Normally it either comes back or your left with other lingering issues.
I know she's suffering. Being patient is hard when your hurting but doing the PT and getting a better Podiatrist would be my recomendation.

[pennimelody]

HI ELM,
I am curious about your caution to avoid surgery at all cost. My orthotics do help, along with the right footwear, and the pads I adhere to the orthotics....but the fact that the 2 injections, especially this last one has made it worse, makes me leery about continuing with them. I've heard more negative results about the injections, and it seems to be what I am now experiencing. I do have a PT appointment set up in the next couple of weeks, can you tell me what the PT regiment is, or how PT might be beneficial.
Thanks, Penni

[ELM]

Injections have a place in bringing down inflamation. They are not a long term solution but they can help get you healed.
One goal of PT is to alter the alignment of your metatarsal heads. Basically change the compression pattern of you foot and takes the pressure off the nerve. They can also use ultra sound therapy and deep massage to lessen nerve pressure. PT's will also be able to give you better advise about inserts in relation to your foot and symptoms.
Surgery should always be a last resort. I am a nurse and I see far too many people spring to surgery; and end up with chronic issues that cannot be helped. Mortons Neuroma and Plantar Fasciitis are the effects of mechanical issues with the foot. Neither are from a brake or a sudden trauma. Normally they are from footwear that is not supportive or just wrong for the persons foot.
Give PT a couple months. If you see no results then go from there. I wish I was closer to you and I could send you to people local to me. A good PT will save you from surgery...I am sure there is someone reading this who knows one local to Manchester.

[MT]

I'd second ELM's suggestion to avoid surgery. I've chatted w/ a couple of Ortho surgeons who I know about it and they've flatly said it's certainly far from a cure and may, in some cases, cause more problems. I've been dealing w/ something like MN (or possibly MTP synovitis) for a couple years now. It's killed my running, but is pretty manageable now that I've bought different footwear and been using a met pad. It might be that you have a case that is really bad (check the diameter of the neuroma against current standards if you've had an MRI) that may benefit from surgery, but I'd highly advise you to get numerous opinions (2nd and 3rd and maybe a 4th). Sorry I can't recommend anyone over in your neck of the woods.

As to the cortisone, there is a mild chance that it can cause lipoatrophy of the fat pad in the ball of your foot. If this happens, it can certainly make things worse and there's pretty much no way to recover that fat. Per the suggestion for the surgery, get someone else to look at it and get their opinion on other options and whether the shot did more damage than good.

Best of luck to you.

Mike

[strandman]

I have done a ton of PT over the years, some worked wonders and some did nothing. It certainly is worth trying, but after a serious effort  with PT and you still have issues, IMO it time to look into getting cut. TWO opinions at least

[hobbsj]

Don't fire the doc yet.  I don't know about your case so I can't comment in any way on what is appropriate.  But, people have the tendency to shop around when they have a specific course of treatment they want from reading online as well as wanting recovery to fit a time table they have in mind.  In reality, forums, friends, etc do not have the education or experience of the professionals.  Usually there is a reason for the course of action the doc takes.  Sometimes its the way billing works due to insurance.  Others its a matter of risk analysis.  Ask the doc about the course of action and get some answers.  Most health care professionals like somebody who wants to know about their condition and be active in the treatment.  And there are good reasons for what they say. For example, for my condition I asked my doc why DIY oven bake orthotics were not a good idea as he had been against them all along.  He informed me that it was the positioning of the foot required when they're made that's hard for people to do on their own.  This is after seeing people comment on these and reading stuff online.  By all means, get second and third opinions-- its your health.  But don't shop around for the treatment you want as this will only lead to problems, but for a doc you trust and can work with.

[pennimelody]

I want to thank you all for responding and providing your opinions, suggestions, and ideas.  I actually have found some relief through trial and error in placing the met pads on my existing orthotics in just the right place...I do think this is about structure of foot, and design of shoe, etc that caused this problem. I also found stretching, icing and heat has helped calm down the nerve.  I see an ortho guy in two weeks, and plan to get fitted for new orthotics...and I am rethinking the PT approach.  I do tend to believe that the body will heal itself, if given the proper accommodations, therapies, and care. I am going to ask for an MRI, and hopefully that will help the professionals know the best course of action. This inactivity is trying my patience.
Penni

[strandman]

Good luck,,,, anything that helps

[Admin Al]

sounds like a good plan Penni. getting cut should pretty much always be a last-resort kind of thing. good luck with it.

I want to thank you all for responding and providing your opinions, suggestions, and ideas.  I actually have found some relief through trial and error in placing the met pads on my existing orthotics in just the right place...I do think this is about structure of foot, and design of shoe, etc that caused this problem. I also found stretching, icing and heat has helped calm down the nerve.  I see an ortho guy in two weeks, and plan to get fitted for new orthotics...and I am rethinking the PT approach.  I do tend to believe that the body will heal itself, if given the proper accommodations, therapies, and care. I am going to ask for an MRI, and hopefully that will help the professionals know the best course of action. This inactivity is trying my patience.
Penni

[pennimelody]

Thank you Al.

[ELM]

I hope you don't go under the knife..not fun. I really think PT will work for you!!

[pennimelody]

Thank you Ed, I see the ortho guy this week, and we'll see what he suggests.. How long did PT take for your condition to resolve.?