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Old 12-02-2004, 04:58 PM   #1
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Diagnosing and imaging a foot neuroma

I want to know the best test for diagnosing and imaging a foot neuroma.

Somebody was nice enough to mention that: Neuromas - particularly around the toes - are usually too small and not well visualized by MRI.

So, if not an MRI ... what would be the best test?

 
Old 12-02-2004, 05:17 PM   #2
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Re: Diagnosing and imaging a foot neuroma

Truthfully,a good clinical exam and possibly the use of a local anesthetic injection to "numb" the nerve. If the injection cures the pain, then there is a strong likelihood that the pain is due to a neuroma.

If you are dealing with the space between the 3 and 4 toes (the smallest being #5) then chances are fair that there really is a neuroma. If you are dealing with the space between the 2 and 3 toes, then chances are not good that it is a true neuroma.

Bottom line, there really isn't a very good test to "prove" there is a neuroma aside from taking it out.

 
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Old 12-04-2004, 03:32 PM   #3
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Re: Diagnosing and imaging a foot neuroma

There isn't any good imaging test to see if there is a neuroma.

 
Old 12-05-2004, 01:18 AM   #4
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Re: Diagnosing and imaging a foot neuroma

Mine was between my 2nd and 3rd toes. Mine was diagnosed with only a clinical exam, there is some kind of "clicking" that the Dr. can feel when he manipulates that area.

A steriod injection relieved the pain for about 3 months. After a second injection I had a reaction to the steriod causing the color to come out of my skin. I had a very white streak that ran from the injection sight to almost my ankle. Since another injection was out of the question I had it removed.

Kathy

 
Old 12-06-2004, 05:36 AM   #5
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Re: Diagnosing and imaging a foot neuroma

Muldor's sign

holding the patient's first, second, and third metatarsal heads with one hand and the fourth and fifth metatarsal heads in the other and pushing half the foot up and half the foot down slightly. In many cases of Morton's neuroma, this causes an audible click, known as Muldor's sign.


Treatment

In most cases, initial treatment consists of padding and taping to disperse weight away from the neuroma. If the patient has flat feet, an arch support is incorporated. The patient is instructed to wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered. The patient is advised to return in a week or 2 to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient's foot and the type of shoes the patient wears. It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position.

Conservative treatment does not work for most patients and minor surgery usually is necessary. Two surgical procedures are available. The dorsal approach involves making an incision on the top of the foot. This approach permits the patient to walk soon after surgery because the stitches are not on the weight-bearing side of the foot. The podiatrist maneuvers the instruments carefully through many structures and cuts the deep transverse metatarsal ligament, which typically causes most of the nerve compression. This procedure can lead to instability in the forefoot that may require attention in the future.

 
Old 12-06-2004, 08:26 AM   #6
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Re: Diagnosing and imaging a foot neuroma

Wow .... thank you for your VERY complete response.

My only question is: will an MRI or ultrasound most likely show the neuroma?

Thank you.

 
Old 12-06-2004, 08:44 AM   #7
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Re: Diagnosing and imaging a foot neuroma

An MRI (magnetic resonance imaging) is used to ensure that the compression is not caused by a tumor in the foot. An MRI also determines the size of the neuroma and whether the syndrome should be treated conservatively or aggressively. If surgery is indicated, the podiatrist can determine how much of the nerve must be resected. This is important, because different surgical techniques can be used, depending on the size and the position of the neuroma. Because MRIs are expensive, some insurance companies are reluctant to pay for them. If the podiatrist believes an MRI is necessary, he or she can persuade the insurance company to pay for it by presenting data to support the recommendation.

Personally, I was told that Neuroma's don't really show up that well on MRI, or make sure you get a foot specialists to read your results..

good luck!!

 
Old 12-06-2004, 07:44 PM   #8
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Re: Diagnosing and imaging a foot neuroma

A diagnostic ultrasound shows the neuroma. I had an ultrasound and an MRI. According to my ortho the ultrasound is more accurate, cheaper and quicker. I would at least have that before moving forward with surgery.

I had the decompression surgery and it was a complete failure. Now I am looking into the traditional surgery.

 
Old 12-07-2004, 06:52 AM   #9
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Re: Diagnosing and imaging a foot neuroma

Creative2,

What is a decompression surgery?? Can you explain the process?

 
Old 12-07-2004, 05:53 PM   #10
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Re: Diagnosing and imaging a foot neuroma

The deep transverse intermetatarsal ligament between the 3rd and 4th toes is severed. It's supposed to make more room for the nerve, but apparently isn't very successful. I didn't know this before hand.

 
Old 12-08-2004, 06:29 AM   #11
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Re: Diagnosing and imaging a foot neuroma

Creative2,

Your decompression surgery sounds like what I had, but it was called a liagament release.

This is what I was told - The ligament release procedure for a Morton's neuroma is quite new, perhaps a year or so old. The results of this procedure do not seem promising.

How long were you pain free??

 
Old 12-08-2004, 11:29 AM   #12
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Re: Diagnosing and imaging a foot neuroma

CJ, Thats what my dr called it, decompression surgery. He said its only good for giving the neuroma more room to heal. But if its not responded to the steroid injections then the decompression surgery wont work. He also said that its less invasive and has a quicker recovery but wouldnt work for me.

When you called your surgery a ligament release I was thinking of what I had done after my stitches came out. My third toe had drifted ontop of the fourth one so he released the ligament to that toe and set it with a splint.

Do you still have pain from the neuroma? I havent had any pain from the neuroma since the surgery, only pain and stiffness from where he removed bone from my toe.

 
Old 12-09-2004, 07:12 AM   #13
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Re: Diagnosing and imaging a foot neuroma

Hi LadyNeon,

I had the surgery April 30th. I had relief from the surgery for approx 3 months. And Now I am back to the same pain all over again. I have adjusted my life style to accommodate this, but all I get is more pain..

I am having another MRI on Monday. I will keep you posted.

Personally, I think my surgeon knows that it did not work. At first he told me to give it 6 months, now he is saying to give it a year and oh!! - "Go for a run and rough up your foot a bit.. "

My foot is full of scare tissue that my last injection the podiatrist could not even get the needle in...

any suggestions........??

 
Old 12-09-2004, 02:43 PM   #14
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Re: Diagnosing and imaging a foot neuroma

CJ:

I never helped with my pain - only made it worse.

 
Old 12-10-2004, 03:38 AM   #15
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Re: Diagnosing and imaging a foot neuroma

CJ- I've had alot more time than most for my recovery. I had the neuroma removed April 21st this year. Things went alot slower than I thought but after all the bandages came off I had to have the ligament released from the next toe over so more time off my feet. Two weeks after that I had a hysterectomy, and again more rest. Now on halloween I ruptured the Plantar Tendon in my other foot. Guess what? more time off my feet. So if it wasnt for everything else that I have going on I think I'd be doing really well with that foot. Its still stiff where the bone was removed but other wise not bad. My third toe on that foot is starting to form a hammertoe where he released the ligament, but I'll deal with that when it becomes a problem.

Has your dr mentioned removing the neuroma? I know when mine didnt respond to the steroid injections the Dr. said that was my only other good option, he didnt like the the decompression surgery since his experiance was he'd just have to come back and remove the neuroma later. I didnt like his answer, since I thought less invasive would be better, so I did my own research and got another opinion. Everything seemed to point to him being right.

 
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