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Feet: More Information
I did some web surfing last night and learned a bit about my condition and its possible treatments.
[lj-cut text="This gets long. Maybe no one but me cares."]
What I have
I have "Morton's neuroma", also called "Morton neuroma" or "intermetatarsal neuroma" or oh, I forget. The nerve has surrounded itself with a fibrous mass in response to continual irritation. Some people say it's squeezed by the heads of the metatarsals; others say it's squeezed between the ground and a transverse band of ligament that holds the heads of the metatarsals together. This usually occurs in the third metatarsal space, but sometimes in the second, and very rarely in the first or fourth. I have it in both the second and third spaces on both feet. Hooray. I got the what, quadrifecta?
Morton's neuroma occurs eight to ten times as often in women as in men. So far I have zero ailments that are not gender-linked. I am so @#$!ing happy that I'm not having children and thus risking bearing a girl, I can't TELL you. I should get a Nobel Prize for that. Anyhow. Back to the feet.
I believe I also have "metatarsalgia" caused by "capsulitis", an inflammation of the capsule surrounding the heads of the metatarsals. I bet this is one reason my pain keeps doing weird things: there are two sources. The capsulitis diagnosis came first, in fact, and has been abandoned or ignored since the neuromas were found. The neuromas are proooobably the primary issue. After all, they're palpably there. They feel sort of like someone put little bundles of hair in between my bones.
What I've tried
I've tried most of the conservative treatments: get out of Stoopid Female Shoes (which I wasn't in anyhow because I'm not stoopid), rest, wear orthotics, get corticosteroid injections. The reason injections are limited to three tries is because they risk shrinking the fatty tissue that pads the bottom of the foot. That is the LAST thing I need.
One conservative treatment I have not tried is wearing a metatarsal pad. For neuromas, these should sit just behind the heads of the metatarsals. They help 1) take some pressure off the ends of those bones and 2) help spread them apart when the foot is bearing weight, so there's more room in the interstices where my nerves are getting compressed.
Today I stuck several layers of moleskin to the bottom of my left foot to simulate a metatarsal pad. (Walgreen's doesn't sell anything so weird as to sit BEHIND the ball of the foot. That might be USEFUL.) I'll see how well this works over the next few days.
I might also want to try a wider shoe. (As if shoes as wide as the ones I now have are easy to find!) The irritation may be indicating that I have to wear very loose shoes. Also, running may have changed my foot size. It can do that.
My options now
1. Wait for the Health Fairy to show up. I have found no statistics on success rates for this approach. Conversation with my physical therapist leads me to suspect they are low.
2. Multiple injections with "a sclerosing agent" such as alcohol. As best I can tell, this hardens the fibrous growth and kills the nerve. I found no statistics on success rates with this. Based on the nerve diagrams and the number of places I have the problem, I believe I should expect this to cause permanent and complete numbness of the middle toe and partial numbness of the two on either side of it.
3. Surgical "resection" (removal) of the nerve. This can be done from the top of the foot or from the bottom; what my doctor has said about aftercare makes me think he does it from the top, and I haven't the foggiest how he gets past that band of intermetatarsal ligament. That's his job to figure out ;-). I guess he pulls on the nerve. They're stretchy. Success rates for this surgery are reported at 80% in some places and as low as 60% in other places. Most? all? failures involve the truncated nerve developing another neuroma on the stump, often more painful than the original. Slight information on the web sites confirms that I should expect this to cause permanent and complete numbness of the middle toe and partial numbness of the two on either side of it.
4. The carpal tunnel approach: cut the intermetatarsal ligament. I didn't find, or don't remember, success rates for this one. It does caution about long-term instability of the forefoot. If I want to run, hike, and climb, I will resist this approach.
Well, now at least I know what to ask my doctor about. My current favorite is the alcohol injections.
[lj-cut text="This gets long. Maybe no one but me cares."]
What I have
I have "Morton's neuroma", also called "Morton neuroma" or "intermetatarsal neuroma" or oh, I forget. The nerve has surrounded itself with a fibrous mass in response to continual irritation. Some people say it's squeezed by the heads of the metatarsals; others say it's squeezed between the ground and a transverse band of ligament that holds the heads of the metatarsals together. This usually occurs in the third metatarsal space, but sometimes in the second, and very rarely in the first or fourth. I have it in both the second and third spaces on both feet. Hooray. I got the what, quadrifecta?
Morton's neuroma occurs eight to ten times as often in women as in men. So far I have zero ailments that are not gender-linked. I am so @#$!ing happy that I'm not having children and thus risking bearing a girl, I can't TELL you. I should get a Nobel Prize for that. Anyhow. Back to the feet.
I believe I also have "metatarsalgia" caused by "capsulitis", an inflammation of the capsule surrounding the heads of the metatarsals. I bet this is one reason my pain keeps doing weird things: there are two sources. The capsulitis diagnosis came first, in fact, and has been abandoned or ignored since the neuromas were found. The neuromas are proooobably the primary issue. After all, they're palpably there. They feel sort of like someone put little bundles of hair in between my bones.
What I've tried
I've tried most of the conservative treatments: get out of Stoopid Female Shoes (which I wasn't in anyhow because I'm not stoopid), rest, wear orthotics, get corticosteroid injections. The reason injections are limited to three tries is because they risk shrinking the fatty tissue that pads the bottom of the foot. That is the LAST thing I need.
One conservative treatment I have not tried is wearing a metatarsal pad. For neuromas, these should sit just behind the heads of the metatarsals. They help 1) take some pressure off the ends of those bones and 2) help spread them apart when the foot is bearing weight, so there's more room in the interstices where my nerves are getting compressed.
Today I stuck several layers of moleskin to the bottom of my left foot to simulate a metatarsal pad. (Walgreen's doesn't sell anything so weird as to sit BEHIND the ball of the foot. That might be USEFUL.) I'll see how well this works over the next few days.
I might also want to try a wider shoe. (As if shoes as wide as the ones I now have are easy to find!) The irritation may be indicating that I have to wear very loose shoes. Also, running may have changed my foot size. It can do that.
My options now
1. Wait for the Health Fairy to show up. I have found no statistics on success rates for this approach. Conversation with my physical therapist leads me to suspect they are low.
2. Multiple injections with "a sclerosing agent" such as alcohol. As best I can tell, this hardens the fibrous growth and kills the nerve. I found no statistics on success rates with this. Based on the nerve diagrams and the number of places I have the problem, I believe I should expect this to cause permanent and complete numbness of the middle toe and partial numbness of the two on either side of it.
3. Surgical "resection" (removal) of the nerve. This can be done from the top of the foot or from the bottom; what my doctor has said about aftercare makes me think he does it from the top, and I haven't the foggiest how he gets past that band of intermetatarsal ligament. That's his job to figure out ;-). I guess he pulls on the nerve. They're stretchy. Success rates for this surgery are reported at 80% in some places and as low as 60% in other places. Most? all? failures involve the truncated nerve developing another neuroma on the stump, often more painful than the original. Slight information on the web sites confirms that I should expect this to cause permanent and complete numbness of the middle toe and partial numbness of the two on either side of it.
4. The carpal tunnel approach: cut the intermetatarsal ligament. I didn't find, or don't remember, success rates for this one. It does caution about long-term instability of the forefoot. If I want to run, hike, and climb, I will resist this approach.
Well, now at least I know what to ask my doctor about. My current favorite is the alcohol injections.
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Sending good health vibes to your poor feet! Maybe the Health Fairy will follow the vibes! :)
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Thanks for the vibes!
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How about trying door number 2 to begin with, holding out the option of door number 3 should it not work? That's how I'd approach this.
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Fortunately, if I choose door number 2, I can still drive a car. Door number 3 means no driving for six weeks. I'd rather not make a long-term medical decision on short-term issues, but I confess I'm glad I might not get door number 3.
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I hope you and your doctor can resolve the neuroma and pain quickly!! Gentle hugs!
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Given this list, I think I'd go for the alcohol injections, too. I wonder whether "Sofia (http://www.liquorama.net/index.asp?PageAction=VIEWPROD&ProdID=21283)" is an option.
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I don't know whether using Sofia would be a waste or a blessing. :-) (Saw the comments in your journal. Was very amused.)
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