Question
Hello, Dr. Katz,

I had the Morton's neuroma surgery (located between 1st and 2nd toes) in October 2006 after using custom orthotics for a few years. As a lifelong athlete (sprinting, tennis, cycling, stair racing, skiing, etc.) I felt the orthotics weren't helping as much as I'd hoped. Any fitness training was impeded and competition would not have been at the level I desired.
Immediately after surgery the foot/ankle orthopaedic surgeon said the neuroma was bigger and deeper than she'd anticipated. Eight months after surgery I am in constant pain and have undergone a series of podiatrist-administered alcohol-based injections into the sensory nerve to cauterize it, to no avail. It's been conjectured that the surgeon may have cut the transverse ligament; the term stump neuroma was mentioned as well, along with phantom pains, etc.
As a layman, I'd describe the feeling as though the fatty pad in the ball of my foot is gone. It also feels as though the metatarsal heads have dropped and have no cushioning. The clicking is now constant, whereas prior to surgery it only clicked every few steps. Now, just putting on a sock is unpleasant. The sensitivity along the top of my foot also is worse now.
I'm going to try acupuncture next. Any other suggestions?

Thank you very much,

Answer
Hi Shawna,

I question whether the initial diagnosis was Morton's neuroma.  I can also tell you from experience that a neuroma is never deeper than you thought unless you have little experience with nerve anatomy.

The nerves are always in the same layer at the bottom of the foot.  Also, when a neuroma is bigger than expected I would question whether a neuroma was removed or a nerve and a bunch of fat padding on the bottom of your foot.

Did your Dr. confirm neuroma with a pathology report?

I suspect that your fat padding was removed along with some of the tendons possibly and maybe a portion of the nerve.  It is possible that the nerve was missed completely.  When the fat pad is removed the bones feel more prominent on the bottom.  

You may have a stump neuroma which can be horribly painful.

There is now certainly some type of nerve damage.  I would strongly consider Crysourgery, see the site below.

However, a more definite diagnosis needs to be made using local anesthetics around certain nerves.

Hope that gets you on the right track.


Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.fix-my-foot.com

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