Thursday, February 16, 2012

A Success Story!

About 2 weeks ago in my last blog posting, I talked about one of the treatment options for painful morton's neuromas - a cortisone injection.  Those who may remember, the "patient" was myself.  I had been having moderate pain in my right foot from the neuroma, and it was getting worse.  I decided to inject my foot with Kenalog, a type of cortisone.  The purpose of the injection was to help to relieve pain, and hopefully cause some shrinking of the neuroma itself. 

After my injection, I noticed an immediate decrease in pain.  This was expected, since I also had included a local anesthetic in the injection.  After several hours, the local anesthetic wore off, and the pain came back just as bad as before.  This was to be expected, and I was not surprised.  I can see how this can be discouraging to patients though, which is why I warn them that he effects of the cortisone can take a few days to become evident.  When I woke up the next morning, I was pleased to find that my pain level was decreased by about 50%.  The next day, the pain was 100% resolved!  That was a welcome relief!  Since that time, I have not had any pain in my foot whatsoever!

The real question now is this:  How long will this pain relief last?  The honest answer to that question is that I really don't know.  In most cases from patients I have injected for this condition through the years I have been in practice, pain relief will last for several months.  I do have some patients who never have symptoms again, others will come back 6 months later stating the pain has returned.  I have no problem with giving injections a couple times per year on an ongoing basis to control symptoms.  However, if the symptoms come back more quickly, it's time to get more aggressive.  I, like my patients, am hoping for the best!  Look for further updates on this subject in the coming months!

Friday, February 3, 2012

Treating a Morton's Neuroma via a Cortisone Injection

As a podiatrist, I have treated the condition called morton's neuroma many, many times over the course of my 22 years in practice.  However, my latest patient hit much closer to home.  Me!  Turns out I have developed a neuroma in my right foot recently, and have had the opportunity to experience first hand what my patients have been experiencing all these years. 

A morton's neuroma occurs in the forefoot and consists of inflammation and swelling of the nerve.  This will frequently cause pain that will radiate out to the 3rd and 4th toes.  Often there is a tingling, burning or shooting sensation reported.  It is unclear the precise cause of this deformity, but damage to the nerve is suspected.

There are numerous treatment options available to treat this condition.  In my office, I like to start with simpler options first.  In my case, I decided to administer a cortisone (steroid) injection to the nerve.  This can be helpful in decreasing the inflammation and pain in the nerve, although the relief from an injection is often not permanent.  Other treatment options include the use of orthotics, anti-inflammatory medications, icing, decreasing activity levels, and surgery.  Like most patients, I would like to avoid surgery!

For your viewing pleasure, I had my assistant record myself administering the injection.  My experience was like that of many of my patients over the years - the injection for a neuroma is not that painful.  The fact that I was able to give it to myself while standing is a good indication that this was not a traumatic experience.  As I continued with the injection, I could feel the area become numb, since I also injected a local anesthetic with the cortisone.  You may notice that the injection took over a minute.  I have found over the years that injecting slower decreases the pain, since the local anesthetic will numb the area as the injection proceeds.  Typically though, the cortisone will take a few days before patients notice relief following a cortisone injection.

http://www.youtube.com/watch?v=DTMJ4KOqcr8

I will update this blog in the coming weeks to let you know if my injection helped to relieve my symptoms.