A question about recurrent stump neuromas
Dear Dr. Zapf,
I could really
use some help & advice. I have developed stump neuromas, in both feet, 2 years
after surgical removal of Morton’s neuromas in each foot. A podiatrist did the
surgical excision. The complications that I had to live with were pain and
inability to walk because of it for 6 months. 1st 2 surgeries:
April 2008. He tried cortisone injections at the surgical sites, both feet,
August 2008, and I was in a wheel chair for 2+ weeks. (He wondered if it was
the volume of fluid with the cortisone that caused me such pain?) [Note: my
women’s size 8.5 foot has been very narrow AAA-AAAAA, and others call it “low
volume”. I have long said that if I were to have silicon implants, they’d be in
my feet]. I tried different oral anti-inflammatories
including naprosyn & Celebrex.
Oh yes, and ice packs are my constant companion.
Finally, about Labor Day, Sept 2008, I went on off-label rx of Lyrica. Did
that for about 3 months. By about November 2008, I had pretty much resumed
previous activities.
Except for a
few years during college, I would say that I led an active lifestyle: riding
horses, running, hiking, rock climbing, cycling, XC skiing, camping, and so on.
Not now. I am lame again. I started training this
spring with my husband on long bike rides. I was doing longer rides, then, it
got to 50 minutes out & there was too much foot pain to ride. I use cleats, so
have an up stroke, not just weight bearing down stroke, on my bike. (I’m a
reasonable weight, but I do use exercise to help control my weight. No
exercise, so weight is shifting & likely increasing. I’d estimate: 5’6” and
140-145 lbs. – not too bad). At my husband’s
encouragement, treat it quickly, don’t wait as long as you did to have the
Morton’s neuromas removed, I went in and have been diagnosed with Stump Neuromas
at surgical site of each foot. 4.5 weeks ago I
underwent Radio Frequency Procedure, ablation therapy, at the stump site of the
right foot. At this point, it appears that this surgery is failed.
Yesterday was the first day that I’d been to the grocery store in 5
weeks. It wiped me out. I couldn’t put the groceries away, couldn’t do
anything from ~1 p.m. to bed time). I took a vicodin (now, for occasional pain
relief, I probably take 2 vicodin a week on different days).Today, I tried
walking on the flat asphalt & concrete walks, with Lidoderm Top patch on top &
bottom of right foot, for 25 minutes. My girlfriend had to come pick me up.
I know that I
want to do something, some treatment, not accept this lameness at 53 years old.
I do not know what to pick, what treatment to try, as 3 surgeries have all
failed, and various treatments have failed. In my case, what can you suggest?
I am looking for a permanent fix. I am not looking simply looking for pain
management, pain control. I am not looking to be on long term rx meds. I am
willing to take herbal/nutritional supplements for a time. If I do need to be
on rx meds, to break the pain cycle, & that would result in healing, then, yes,
of course, I am willing to do that. For the activities
that I do, I have to know where my body & feet are, in space and on the ground
(or bike, or rock, or stirrup, or ski, etc), or something that is simple can
become dangerous. i.e. hiking on a rough trail, can’t feel what’s under my
feet, could result in a threatening & dangerous fall while walking in the
Colorado Rocky Mountains.
Thank you for
your help in considering this. It is my hope that while I may be the one
suffering and living with pain and current inability (not yet ready to call it a
disability), that all might learn from my case. I look forward to your advice.
From what I read on your web site, I am wondering if you will recommend
cortisone. Yet, recall, that I did not have a good post-op experience w/
cortisone injections. And, I was off my feet, except for bathroom privileges,
for 3 days following the injections. I can’t wait to
hear what it is you’ll have to say, because after this much trial & error, I am
looking for that guarantee, that magic silver bullet. I am willing to do the
work. My God, the reward is walking – who wouldn’t!
Best regards,
Belinda
Dear Belinda,
Thank
you for your letter. I am sorry about your experiences. It is always troubling
when anyone has a complication from their surgery. So, first thing I would
recommend would be to make sure that your stump neuromas are really the cause of
your pain. This could be done by injecting a small quantity of anesthetic at the
site of the stump neuromas and see if that turns off the pain for as long as the
neuroma remains anesthetized. This maneuver would help to rule out all of the
nonlocal causes of your pain.
Once
we establish that you really do have stump neuromas, I would suggest treating
them with a series of alcohol injections. This technique is called chemical
neurolysis and involves injections of the lesion(s) with 4% or 11% ethyl
alcohol. Quite possibly your podiatrist already does these injections. If not,
it would not be difficult to learn how to do them. If you had your podiatrist
call my office I can talk them through it. Traditionally, a stump neuroma needs
to be approached with an incision on the bottom of the foot. A bottom/plantar
approach has the risk of creating a painful and uncomfortable scar so you would
like to avoid the surgery if you can. And I applaud your doctor or try a
radiofrequency ablation seizure. That is a sophisticated technique and is,
probably, one of the most appropriate treatments for such a condition. I bet he
or she also does alcohol injections for neuromas. Good luck.
