NEClimbs.com forum

General => Injuries, Medical & Training => Topic started by: smartpig on February 17, 2013, 10:15:04 AM

Title: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: smartpig on February 17, 2013, 10:15:04 AM
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 (http://www.mountainproject.com/v/mortons-neuroma/106909115#a_106939468).

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

       
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?
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: strandman on February 17, 2013, 10:18:50 AM
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 ???
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: perswig on February 17, 2013, 01:35:17 PM
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
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: ELM on February 17, 2013, 04:00:07 PM
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.
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: pennimelody on February 17, 2013, 04:12:24 PM
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
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: ELM on February 18, 2013, 08:43:47 AM
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.
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: MT on February 18, 2013, 01:44:34 PM
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
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: strandman on February 18, 2013, 03:19:26 PM
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
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: hobbsj on February 18, 2013, 07:22:00 PM
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.
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: pennimelody on February 21, 2013, 07:15:22 AM
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
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: strandman on February 21, 2013, 08:42:23 AM
Good luck,,,, anything that helps
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: Admin Al on February 22, 2013, 02:23:05 PM
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
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: pennimelody on February 24, 2013, 07:11:45 PM
Thank you Al.
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: ELM on February 24, 2013, 07:42:33 PM
I hope you don't go under the knife..not fun. I really think PT will work for you!!
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: pennimelody on February 25, 2013, 11:27:01 AM
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.?
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: ELM on February 25, 2013, 05:49:10 PM
I have never had a Mortons neuroma. For a neuroma I would expect to see changes in 4-5 treatments. I have had extensive PT for shoulder and elbow issues. I put off surgery on my elbow for 10 years. PT did help but the pain and loss of mobility is what eventally led me to surgery. Post op I really saw a change after the first few PT treatments. My pain has been gone since and that changed everything. I would not be climbing if I had not gotten it operated on. My shoulder is another issue. I really have to do lifetime work with it to keep up my ability and prevent dislocations. Surgery could improve the stability but I would be risking losing range and flexability. With PT I can climb with it. If I worked on it more I could climb harder too.
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: lucky luke on March 04, 2013, 09:55:40 AM
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.?

I have a Morton's Neuroma for three years by now. It is very painfull. I am going to the doctor 10 april and will have the operation. I had carpal tunnel too. When the nerve is too thick, there is nothing you can do, except to cut and remove the bad part. Expect a lost of sensibility in the small toes. don't wait too much it is very hard to sustain particularly when you are in the cliff.
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: Admin Al on March 04, 2013, 08:13:44 PM
let's try to keep postings at least SOMEWHAT on topic folks...
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: pennimelody on March 06, 2013, 08:31:19 PM
Getting 2nd or 3rd opinions is great advise. After going to a podiatrist(not the best choice to start with), and two cortisone injections after I went to a Physical Therapist  and Orthopedist. The diagnosis is not a Nueroma, (both PT and Ortho Dr. concurred),but a structural problem requiring metetarsil orthodics.  I did not have to go through an MRI. I also would caution getting injections until you know clearly that it is undeniably a Mortons Neuroma.   I went to an orthopedic Dr. who specializes in foot and ankle conditions, along with a good PT who knows her anatomy.  The long and the short is to make sure you seek proper medical care to know what the foot conditions is. Climbing shoes are not forgiving foot wear, and consequently, when problems feet arise, you have to take care of them if you want to continue climbing. :P
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: sneoh on March 06, 2013, 09:16:33 PM
So, good news and no surgery then.  Congrats.
Definitely get 2nd or 3rd opinion especially if surgery is unavoidable.  I am glad I did for my wrist surgery.  First doctor recommended a procedure that would likely have resulted in a significant reduction of my climbing ability.  The second recommended (and I accepted) a much less intrusive but cutting edge procedure, for 1997.  I am grateful 16 years hence; I am still climbing within one or two letter grades of my my personal best before my injury and surgery.  Certain types of hand moves are a lot harder because of reduced range of motion but I am learned to adapt and work around the loss of wrist flexibility.
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: ELM on March 07, 2013, 07:53:35 AM
It's good to hear you got a better diagnosis. Gotta take care for your feet!  ;)
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: Admin Al on March 07, 2013, 06:13:13 PM
good good GOOD news Penny!

Getting 2nd or 3rd opinions is great advise. After going to a podiatrist(not the best choice to start with), and two cortisone injections after I went to a Physical Therapist  and Orthopedist. The diagnosis is not a Nueroma, (both PT and Ortho Dr. concurred),but a structural problem requiring metetarsil orthodics.  I did not have to go through an MRI. I also would caution getting injections until you know clearly that it is undeniably a Mortons Neuroma.   I went to an orthopedic Dr. who specializes in foot and ankle conditions, along with a good PT who knows her anatomy.  The long and the short is to make sure you seek proper medical care to know what the foot conditions is. Climbing shoes are not forgiving foot wear, and consequently, when problems feet arise, you have to take care of them if you want to continue climbing. :P

Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: pennimelody on March 08, 2013, 11:18:28 AM
Thank you Al:)
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: lucky luke on March 14, 2013, 02:10:21 PM
Getting 2nd or 3rd opinions is great advise. After going to a podiatrist(not the best choice to start with), and two cortisone injections after I went to a Physical Therapist  and Orthopedist. The diagnosis is not a Nueroma, (both PT and Ortho Dr. concurred),but a structural problem requiring metetarsil orthodics.

Going to the doctor the 10 april....not sure if I want an other diagnostic than a morton neuroma as the operation is easy and final. I hope that you have a definitive solution for your feet and don't have to buy/pay for treatment for some other years, to have the operation many buck in other pocket than yours. For me, it is not structural bones for the moment. I had pain in my right foot as I climbed children crusade and can barely do the move...leading.
Metetarsil is the name of the bone and the nerve is going a long that bone. if you change how the friction occur, you will feel better...for a while and you will have other problem. Ask your doctor if it is a friction of the metetarsil to the nerve, which increase in size and make an obstruction or if it is a tendon on the metetarsil who create the pain. I read, no experiences, that the nerve can regress to a normal size after a while.
In my case, the pain is often associate with the presence of cigarette smoke. When someone smoke around, three or four hours later I have a pain in my right feet. I don't know exactly what it is. My allergy can attack the nerve is my explication. 
Title: Re: Morton's Neuroma_looking for specialist surgeon, Manchester area?
Post by: lucky luke on April 12, 2013, 01:03:00 PM
Going to the doctor the 10 april....not sure if I want an other diagnostic than a morton neuroma as the operation is easy and final.

went to the doctor yesterday: diagnostic is a morton neuroma, she heard the caracteristic "click" and will go for emr. It is free here in quebec or 500$ in private clinic.

Treatment is: metatarsil pad first....
if it's not working, injection
if it is not working, operation... in about a year still.

As a climber, pad didn't work in our shoes. So, I just hope that the thickness of the nerves was cause by and other situation than climbing, which is the case as I can climb for days without pain. If you take a close look of the problem, it is a thickness of the myeline sheat. Nothing to do with the tendon, so it can't come back. Nothing attack the sheat of the nerves, except some disease very awfull.

(http://www.google.ca/imgres?imgurl=http://img.tfd.com/MosbyMD/thumb/myelin_sheath.jpg&imgrefurl=http://medical-dictionary.thefreedictionary.com/myelin%2Bsheath&h=144&w=250&sz=8&tbnid=Oyh-9EZKGgwYmM:&tbnh=67&tbnw=117&prev=/search%3Fq%3Dmyelin%2Bsheath%26tbm%3Disch%26tbo%3Du&zoom=1&q=myelin+sheath&usg=__GKevEwAXXcBIdKpr7r6WZDJWT3A=&docid=XmavMomPNPZNLM&hl=en&sa=X&ei=iz1oUdrZBIe64AOctIDIBw&sqi=2&ved=0CEoQ9QEwBA&dur=906)