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.

94 comments:

  1. I'm having this done in both feet in 2hr & very nervous, didn't enjoy watching the clip but it did make me think it's clearly not as bad as 'injection in your feet' sounds! or the guy's in to pain:-)

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  2. I can assure you, I am not into pain! The reason I injected myself was to end the pain I was having. For me, the pain was resolved with the injection. It has now been over a year, and there has been no return of symptoms. However, not everyone responds the same. I would be interested in hearing how your experience with the injections was, Anonymous!

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    1. I had a mri which determined I have a mortons neuroma. My podiatrist didn't feel I need surgery as it is small. He gave me two injections in my left foot yesterday. It was quite painless as he froze the area. However the second shot I heard something burst, he told me it was the envelope which was a good thing. So far so good. I cant wait to be able to walk without pain, dance and wear other shoes other than sneakers Unfortunately my podiatrist does not feel that othodics will help or cure my neuroma as he has operated on many people who had orthodics and didn't work. thanks for your insight.

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  3. I had an injection this afternoon and am having pain at the injection site. I'm hoping it feels better in a few days.

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  4. I've had 2 shots and wore a removable cast for 3 weeks and it's still not better. Now he wants me to wear the boot another 4 weeks and if still not better, another shot. The problem that I'm having is that now there is atrophy of surrounding muscle and bone.

    Any suggestions on how I can get my Dr. to look at different possibilities?

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  5. Anonymous - There are other options if more conservative treatment is not working. You may want to consider functional foot orthotics, or perhaps surgery. An ultrasound or MRI might also be something to think about to confirm the diagnosis of a neuroma. Good luck!

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  6. I have mortons neuroma in both feet and right now the left is so bad i can't workout or if i do i can't walk on it very well - i have had cortisone shots in both feet twice and tried the alcohol injection shots - my question is how often can i get injections in the foot - they told me only twice in each foot - they won't give me anymore and surgery is not an option at this time - any other advice - one doctor said i can have up to 2-3 a year and the other said no as it causes too much damage - help - in pain all the time

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  7. I do not like to give more than 3 injections per year. However, if prior injections have not helped to relieve symptoms, I think it's time to try something else. If you do not have functional foot orthotics, this is the time to ask you podiatrist about having some made. After that, I'm afraid that surgery is the next step. It would be nice if surgery was never required to treat this condition, but sometimes, it is required, appropriate, and can get rid of the problem for good.

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  8. I have bunions...and bunionettes on both feet. First, my big-toe bunions were killing me. I iced them for 4 weeks and they got better. Then the pain migrated to my little toe bunions. I did a lot of physical therapy, ice, and it got better. Then...the pain migrated to underneath my 3rd and 4th toes. Nothing I did could really fix it. I had custom orthotics made and they helped, but from time to time, I need to wear, "pretty shoes" for my job, and this began a whole new weeks long series of pain underneath the 2 toes - like there are rocks stuck on them, jabbing at the nerves. Today, I went to a new podiatrist and he gave me injections. Strangely, the left foot feels better already, but not the right foot. It has only been 6 hours. I'm going in for the second injections in 2 weeks. I hope this works. I've been at this ordeal for good while.

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  9. Oh...and the injections were not painful. Mild menstrual cramps are a whole lot worse than these injections. If you have them done, just close your eyes, don't watch and take a few deep breaths. It is over in a few seconds. :)

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  10. I had an injection yesterday at this time and am still numb in my 2 toes around the injection point. Is that normal?

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    1. Yes, that can be perfectly normal, especially if a long-acting local anesthetic was used along with the cortisone. The numbness will go away - although I have had some patients say it lasted for up to two days. Normally though, it lasts just a few hours.

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  11. BTW--my injections WAS painful! Just sayin.

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    1. When patients ask me if an injection will hurt, I am always uncertain how to answer the question, because everyone responds to injections differently. I will say though, that for most of my patients, injections for a neuroma are tolerated much better than injections given for heel pain (plantar fasciitis). Either way, if the pain resolves, I feel it's worth it to go through a brief bit of discomfort (or pain) in order to achieve long-lasting relief.

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  12. For those who have had various treatments for neuromas, I welcome your comments here on how you responded!

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  13. I had my second cortisone injection yesterday. Both injections themselves were painless, as I was quickly numbed prior to the injection. I wasn't in a lot of pain immediately prior to my first injection, so didn't notice much of a change following the injection. However, after an event that had me standing for long periods of time, I needed the second treatment. Today, one day following the injection, I'm noticing the nerve is really tender and hurts worst than prior to the injection. The injection site on the top of my foot looks fine, so I don't think I'm having any sort of negative reaction to the medication/injection. Is it normal for the nerve to be 'aggitated' following an injection? I took Motrin, have iced the area and used Voltaren Gel around the foot just to help. Am waiting to see if that relieves the discomfort before calling to bother the doctor. Thank you for any advice you can provide.

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  14. Your assessment is likely correct - the nerve was likely irritated during the injection. However, this may not be a bad thing. That does indicate that the medication was placed right by the neuroma, and hopefully, once it starts to take affect, you will notice an improvement in your symptoms. Usually, it takes about 2 to 3 days for the symptoms to subside following an injection.

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  15. Thank you, Doctor. I'm waiting for a call back from my doctor just to be sure as well.

    PS -- I've also tried accupuncture for the neuroma and have had mixed results. One doctor was excellent, and I would walk out pain free. His associate... not so much. Have to admit though that the cortisone shots are much less painful than multiple accupuncture needles in the foot, which is extremely sensitive. I root for the injection over accupuncture, but it might be another option for people to try to avoid surgery.

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  16. I had injections in both feet in January and it has made the condition worse. Before the injections I would only get pain after walking for 1 hour. Now the pain is there when I first get up and throughout the day. I have now got orthotic insoles which help a lot. I wish I hadn't had the injections and had just gone for the orthotics. Also the tops of my feet in the area of the 4th toes are pale as if bleached and the skin inside my 4th toes is numb.

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    1. It would be wonderful if every treatment we use to treat patients worked every time. Sadly, this just is not the case, and it never will be. In the case of treating neuromas, there is a reason why there is more than just one treatment option - because there is no one option that works for every patient every time. Indeed, if injections and orthotics worked every time, we would never need to perform surgery for this condition. But sometimes surgery is required. It is unusual though, to have injections cause more pain afterwards. As for the discoloration of your skin, that will go away in time, as will the numbness, most likely.

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  17. I had the injection this afternoon. Was not painful (I couldn't look). Definitely not as bad as having to give yourself heparin shots. I feel that the pain is subsiding, and I am sure that by the passage of time it will be pain free.
    Cindy

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  18. I had an injection for this today in my left foot - between 2nd and 3rd toes and it was acutely painful. The burning sensation running up my third toe had me biting my tongue to keep from screaming. Now, 18 hours later, I can't sleep because the pain and swelling is so bad. Obviously, this is abnormal. I had an injection for carpal tunnel years ago and it was just as bad. I wonder if I'm extra sensitive to this.

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  19. The two comments above are a perfect example of why it is so hard to answer the question I often get before administering an injection of any kind. Namely, how much will this hurt. Fact is, everyone is different in their perception of pain. I have also found that I can give two injections to the same person, the same day, and one will hurt more than the other! In the end though, even if an injection is painful, if it works as intended to relieve pain long term, in my mind, it's worth it.

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    1. I'm not sure if you're still answering questions on this thread, but here goes: I've had two injections in both feet. I was not numbed (is this normal?). They hurt, but were bearable. How does the doctor know where to inject the medication? He basically just asked me to point to the area(s) on my feet that were painful. I have had x-rays, but not an MRI or ultrasound. Would either of these tests help pinpoint a better injection site? If so, which would you recommend? Thank you.

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  20. I have had this pain in my foot for about 2 months. My chiropractor tried tens unit and laser treatment before sending me to a podiatrist. I was pleased with my Dr. I explained what was happening and that along with those 2 treatments I have also purchased new tennis shoes and I never wear dress shoes other than sandals to work. I work a sit down job so I am not on my feet and if I decrease my activity level any more I will be sleeping all the time :). I also was taking 600mg motrin 2 x day (RX stregth) and putting ice on my foot but yet it still hurts to walk no matter what shoes I do or do not wear. He put the cortisone injection in my foot (whicih was not too bad, stings a bit but nothing unbearable) and my foot was numb for most of the day. The shot helped for about 5 days and for almost a week and half I have been hurting again. The swelling is bad enough that you can visibly see the swelling on the bottom of my foot. I go back to the Dr next week and he is more than likely going to do another injections. He said if that will not work then I will probably have to have the nerve shaved off some. He said I have an acute case....WONDERFUL! All
    I know is it is painful and when I called to get back into his office sooner the nurse said it usually takes 10-14 days for the cortisone shot to work. I find that hard to beilve when the pain was nearly gone for 4 days and has slowly come back to the painfulness it was before I saw him. Will the next injection possibly work or am I defeating the purpose and just putting a bandaid on something that is not going to get better without surgery? Thanks :)

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  21. Stori,

    In my experience, patients usually start noticing improvement following a cortisone injection within 2 to 3 days. What I do not know is what exactly your doctor injected into your foot. There are different concentrations that can be injected. I feel a lower concentration is not as effective. You may ask him about that. If it were me, I would go ahead and try another injection. If it helps, fantastic! If not, you can still have surgery done. One other conservative measure you may want to as you podiatrist about is having functional foot orthotics made for you. If all these measures fail, surgery is the next step. And while no one wants surgery, this procedure is one most patients recover quickly from, and it should take care of the problem for good.

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  22. He injects with a steroid and long acting numbing medicine. He looked at it and said it was not much better after the 1st shot so he opted for another (and stronger) shot. This time it did not hurt much again but it did leave a nice *pretty* bruise. Once again the pain is much better but it has only been 3 days. It did this the last time. He said that since we have tried most everything else he is worried that the nerve is so inflamed and swollen that nothing much will work other than removing the acutly swollen branch of nerve. The only bad thing is I have to come up with my deductable (which is around $4k) before I can have it done. I am hoping the injection works but he is not so sure it will. He said to just call him in 2 weeks and let him know how it went and we will go from there. He said that there was no point in making me come back in to just talk since he cannot do another injection. I guess I will be looking into how to come up with my deductable just in case :(

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    1. Any update, Stori? I am in the same boat and miserable. Curious to know if you've found relief with a more effective treatment. Thanks.

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  23. Have you had any experience treating neuromas with elite athletes or ballet dancers? I am a ballet dancer who has been struggling with neuromas in both feet for the past 8 - 11 months. The pain is exacerbated immediately when I put on my point shoes. I wear met pads in my zero drop (wide front) tennis shoes, but the pain is terrible when I am dancing. Do you think I should try the injection?

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  24. In my practice, I do not see a lot of elite athletes. I have treated some dancers though, and they present a unique challenge. Orthotics cannot be worn in your ballet/dance shoes, so that option is off the table. As far as an injection goes, that would be my first choice of a treatment in your situation. If it is unsuccessful, you may have to consider other less conservative options (perhaps surgery).

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  25. Good afternoon:

    I have had the cortisone injection for MN, I was pain free for 7 months; The pain has returned. I am apprehensive when it comes to having another injection mainly because of my fear of muscle atrophy or elevated blood pressure since I have hypertension. My working out plans are on hold for now since I like to do Zumba. How can I avoid another injection and still be able use my feet? Thank you for your time.

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  26. When you receive a cortisone injection, the medication is deposited at the site of the injection. Because of this, the amount used can be quite low, and systemic effects such as having an elevation of your blood pressure are highly unlikely (your blood pressure may go up temporarily during the injection simply as a result of the stress you may experience from the injection itself - not what is being injected). As for muscle atrophy, at the site where the injection takes place, there really is not much in the way of muscle tissue - it's mainly tendons, so muscle atrophy is also not much of a concern. If the injection is placed properly, the neuroma itself might atrophy, but that is by design. Personally, I thing 7 months of relief following an injection is fantastic, and would not hesitate giving a second injection. I worry more when there is no relief, or relief is only seen for a matter of weeks or a month or two. So my advice would be to have the second injection. If you are dead set against it, your options include orthotics, rest (stop exercising or change to an activity such as swimming or cycling), the use of of a walking cast to rest the foot, or surgery. And while surgery can eliminate the problem permanently, it is certainly more aggressive than another injection.

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  27. Very helpful, thank you.

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  28. Have MN in my R foot and have received 3 cortisone shots over the course of 18months. All three have worked within 24hrs post injection and lasted almost 6 months each. Injection was slightly painful but I usually just exhale while he injects. Very happy with the pain relief of the shot. Also have custom orthotics which help greatly as well.

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  29. I had an injection today for a MN in my right foot. There was an instant of pain as the medication hit the inflamed area, but it resolved quickly after the marcaine started to work. I am hopeful it will be helpful, as I am a runner and a cyclist. I plan to lay off running for a period of time to allow the area to quiet down. Thanks for posting your video... I would say you are pretty tough to be able to inject yourself..

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  30. I've had 3 shots in 4 months all on dorsal surface of my foot. The first was to treat 2nd MT capsulitis, and the second was done 1 wk later to treat neuroma b/t 3rd & 4th. The third was done 3 months later to re-treat the neuroma. My neuroma pain is gone, but the 2nd MT pain has returned. I'm worried I have plantar fat pad atrophy. How can you tell? Did I get too many injections?

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  31. You have to realize that when you receive an injection in your foot, the medication pretty much stays where it was injected. So receiving injections in different areas does not increase the risk of atrophy. I would think that a second injection 4 months later would be safe to proceed with. However, since I was not the one doing the injection, I have no way of knowing exactly what was injected. Some medications have higher potency than others. Even still, I think most podiatrists would be comfortable administering a second injection 4 months after the first.

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  32. I have neroma on both feet. Left is much worse though. Orthotics were my first choice of treatment and help alot...until now. The left foot has become very painful. I cannot walk around barefoot. I also have a bunion on the left foot that has become worse also. Could the bunion be causing the neuroma to worsen?

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  33. I was diagnosed with a neuroma back in 2001 (I remember picking up my new,custom orthotics on Sept 11...) A single cortisone shot, custom orthotics, and transition to wide shoes took care of it for 12 years. Fast forward to this year. I began jogging in January, got fitted for appropriate running shoes that fit my orthotics, and have done 3 5K races (slow). Never felt a twinge of neuroma. I went to Alaska and wore knee-high rubber boots for 3 days on a rafting trip, and all of a sudden neuroma flares up.

    I took antiinflammatory and iced and it got a little better but not completely. Got a cortisone shot and that doesn't really seem to have helped. Should I go for another one (it's been almost 2 weeks)? I went running once and didn't feel any worse afterwards, but should I stop running altogether until this is resolved?

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  34. I have a neuroma that was diagnosed last September. This was after I twisted my foot and in between multiple stress fractures at two different times--all on my right foot (bad year and clumsy year for me). Foot healed fine until around two months ago. I started getting pretty bad pain on the pinky toe and right side of my right foot and the neuroma started again. The pain on the side I found out today is a tailor's bunion (bunionette) and the neuroma I received a shot for. My shot did not hurt but it seemed to last forever and my doctor said she needed to go slow so there was not pain--I was grateful.

    Tonight my foot is achy and still partially numb. She said exactly the same thing that you said Dr. Quist. She said when it comes to neuromas, that she guarantees nothing because different treatments have completely different results, sometime they work, sometimes sugery becomes the only option and she doesn't see a correlation. She prefers the conservative approach to try different methods.

    I will be getting orthopedic shoes to help with the bunionette and hope to get relief from that. Darn those high arches! I am someone who had to wear the ugly orthopedic shoes when I started school when I was little and am not thrilled about having to wear them again to work but the pain will trump this argument as well as anything to avoid foot surgery (had that once, and well....)

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  35. I'm grateful to have found your blog, Dr. Quist. I am a 55 year old woman diagnosed today with MN and had a steroid shot (which was only a little painful) about 3 hours ago. Right now, my foot pain feels much, much worse than when I went in the office and slightly numb. I can barely tolerate standing on it and can only hobble. Is this normal? What should I do? (Ice, medicine??) When might this resolve (I'm going traveling next week, so if this doesn't subside quickly, I have a big problem). Thank you.

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  36. Hi I have N/m in my right foot, between my big toe & next. My big toe & 1/2 my foot has been numb for about a month, I had my injection on Monday, & it hurt. The pain now is much worse, my whole foot and ankle hurts, the pulsing pain has become worse. I find it hard to walk on my foot now, it is Thursday today. Any ideas how long this pain will last, as I've been off work all week, I dont get paid, when I'm off work, and feel I cant work with my foot this painful. I work 10 hrs a day and am on my feet all day. :(

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  37. Anonymous (from 9/24, 10:37): The two deformities are not related - I do not think that your bunion could be making your neuroma pain worse, unless your shoes are not wide enough to accommodate the bunion. Shoes that are too narrow can make neuroma pain worse.

    Anonymous (from 9/24, 11:03): I think it's probably too soon for another injection, especially if your doctor injected a higher potency cortisone into your foot. I would wait at least a few months before giving another injection myself, although your doctor may feel otherwise.

    Anonymous (9/26): Pain after an injection can occur, but it usually does not last. I would be patient and wait a few days for the cortisone to start taking affect. In the mean time, anti-inflammatory medications such as ibuprofen are helpful, as well as ice, and avoiding activities that aggravate your symptoms.

    Sandi: I think you need to go back to your doctor so he can re-examine your foot. In my experience, it is rather unusual for a neuroma to occur between the 1st and 2nd toes. Most commonly they are found between the 3rd and 4th toes, and less commonly between the 2nd and 3rd toes. It is also unusual for pain to last as many days as you are describing.

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  38. I had an injection last week and the pain is now much worse, Before the injection the pain was like stepping on a pebble and very isolated. Post injection (5 days ago) I cannot push up to my toe without a shoe on and the entire length *(from 2nd toe to 5th) in 5x as painful. I am hesitant to see this doctor again.Any advice?

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  39. It sounds like you're experiencing a steroid flare. This uncommon reaction is due either from trauma from the injection itself, or irritation of the tissues from the cortisone that was injected. The symptoms should subside in time. Rest, ice and anti-inflammatory medications should help with the symptoms. I doubt that your doctor did anything wrong to cause this. Sometimes, things just happen. To my knowledge, this has happened to two of my patients following injections I have administered. After 24 years of practice, that's not too bad (unless, of course, it's you who's experiencing this painful reaction).

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  40. I just had a steroid injection for my neuroma that has flared back up with training for a marathon. How long do I need to wait to begin running again? Thank you!

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    1. Rose, has there been any update? I have had to sideline my marathon endeavors due to this as well. I am curious to see what other runners are experiencing.

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  41. Rose - great question! I would wait until symptoms start to improve, which should be in a matter of days. When you start training, gradually increase the duration and intensity of your workouts. If the pain returns, you'll need to go back and see your doctor.

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  42. Hi...I am a triathlete disgnosed a couple months ago with nueromas in both feet. I stopped running for a couple of weeks, didn't help much, tried cortisone and it made it did not help at all. So, I will now have my third alcohol injection tomorrow. I am seeing slow, but steady, reduction in symptoms. However, I am still not running. I do swim and bike (being careful to not stand or do any intense climbing efforts). My question is, at what point do you think it would be safe to try running again? If the injections are showing improvement, but still not pain free, do you think it is best to wait until you are pain free or would it do any damage to give it a test run? I have not ran in 7 weeks and have an Ironman the end of March. I'd like to start training as soon as it seems smart, without setting my training back any further. Also, one other question, my nueromas are between the 3/4th toes, but I now notice mild pain at the base of the 2/3rd toes after cycling. Could this be from additinal nueromas or putting pressure in different areas of the foot due to over compensation. There is no numbness or tingling in the second toes, like there is in the 3rd/4th. So, I wonder if this is just irritated or other nueromas. Oh boy!! Thos has been quite a journey!

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  43. How long do I need to stay off of my feet after an injection? My doc said a day but it was not enough last time. Also, I was icing the bottom of my foot and had bad pain and then nothing. I am wondering if the envelope broke. Thank you.

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  44. Has anyone ever considered using botox to deaden a neuroma? Just a thought and I found this study.
    http://www.ncbi.nlm.nih.gov/pubmed/23740337

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  45. Woodybiz & Anonymous - resuming activities following an injection is dependent on how your foot feels. Ease into activities gradually. If your foot feels good, proceed. If not, then give it more rest. If you continue to have symptoms, go back to your doctor for other treatment options.

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  46. Extremely active 49 year old. Started feeling pain in my left foot 12 months ago. Always felt better when running in New Balance. Maybe wider toe box and better support made the difference.Finaly went to see the doc as it slowly got worse. Had my shot yesterday and hope to resume activities on Friday. Although less than a centimeter in size, if this does not work, I'm having surgery. The incision is on top of the foot...does not seem that bad when you consider you're done with it for good. Too much cortizone is just not good. Question: Could the fact that I had knee tendonitis in my right knee two years ago have caused the neuroma in my left foot? Maybe the result of compensating for the right knee as I ran or biked?

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  47. A couple of thoughts. While surgery is usually successful, it IS NOT ALWAYS successful in relieving pain from a neuroma. The risks of surgery, while not high, are in my opinion more significant than the risks of an injection of cortisone, as long as it's not overdone. Typically, most doctors will not administer more than 3 injections per year in any one location. I'm not saying surgery is not the right option for you, just make sure you've explored all conservative care first with your doctor before rushing into surgery. Hopefully, what you have already done will take care of things so that you won't have to worry about further treatment. As to your other question, I do not think the tendinitis in one leg has anything to do with a neuroma in the opposite foot.

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  48. I'm an Irish step dance instructor experiencing very mild/occasional MN symptoms for a decade. In 2011 a misdiagnosis of plantar fasciitis had me wearing a malleotrain brace that compressed the forefoot, causing increase in MN symptoms (electric shock, toe pinching). Then a proper sesamoiditis diagnosis this fall had me using pads to offload the ball of the foot, but again increasing MN symptoms, until they are nearly constant when dancing and extremely debilitating. I wanted to go straight to surgery, but my ortopaedic man insisted on conservative route - 1st cortisone shot this morning. Shot unpleasant, site slightly numb, but so far no neuroma symptoms. He envisions a course of 5-7 shots, but it sounds like 3 should be the max in a short time frame. Dr., thank you so much for this informative site!!!

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  49. I have injection yesterday on my both feet, was very painful, I can't sleep because the pain, don't know is this normal....

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  50. It sounds like you're experiencing what is called a steroid flare. This is temporary inflammation and pain following a cortisone injection. It is not very common. I would recommend rest, icing the area, and possibly taking an anti-inflammatory medication such as ibuprofen until symptoms subside. If symptoms continue, let your doctor know.

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  51. Hi - I have found this site very helpful. Thank you for posting. After my wedding I had a lot of pain between my 3rd and 4th toes every time I took a step. I went to a dr who took an x ray and said it was a fracture in my 4th toe. So I wore a boot for a few weeks. As soon as I stopped wearing the boot, the pain came back. So I went back to the dr yesterday who injected the ball of my foot with cortisone between my 3rd and 4th toe. As soon as she started injecting the cortisone, my toes completely spasmed. My the 3rd and 4th separated and started cramping and the pain was excruciating. The dr said she heard a click as this happened. She said she thought this might be a neuroma. Does it sound like a neuroma to you? Should I be concerned my toes instantly cramped even though the injection site was inches away? I am in a lot more pain now than I was before. Can hardly put any pressure on my foot at all. Thanks for your guidance!!!

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  52. My injections were very painful...felt like the needle was going through the ball of my foot.

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  53. The that toes cramped during an injection is not that unusual - just a reflex from the pain from the injection. As mentioned in earlier comments, you really cannot judge the effectiveness of a cortisone injection for a few days. Hang in there, and hopefully, you'll notice relief soon. If not, talk with your doctor to determine what else could be going on to cause your pain and what other treatment options are available.

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  54. I am concerned about surgery in all aspects including cost for each or both feet and I also heard it can cause the permanent painful numbing sensation at a 50/50 chance. the shots are so painful for me. maybe im seeing the wrong doctor, but Id like to know your take on surgery please!

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    1. Anonymous... do I understand correctly that you have already had injections for your neuromas and they did not help? If so, and if you have tried other conservative measures such as wider shoes and orthotics, surgery may be the right thing for you. I find that the success rate is better than 50/50; however, there is a small number of patients who will continue to experience pain even after surgery. Most patients see improvement in symptoms, if not complete resolution. Cost is also a consideration. Surgery is not "cheap." If you decide on surgery, I would ask ahead of time to find out what your portion of the bill will be. Make sure you find out about not only the doctor's fee, but also the hospital/surgery center and anesthesiologist fees as well. Good luck!

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  55. hi just wondering about long term side effects from cortisone into my foot .I had a shot a year ago and it took care of the pain from my neuroma but a year later its back ,considering another shot worried about how often i should or could have one and any possible damage to cartilage tendons or ligaments from a second shot .

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    1. Getting an injection yearly is pretty safe. Most doctors will shy away from giving more than three in a year's time, so you should be fine.

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  56. Is this cortisone,DEXAMETHASONE SODIUM PHOSPHATE, 1 MG and what does a night time boot do for Mortons Neuroma?

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    1. Dexamethasone Sodium Phosphate is one type of medication we use. When I say "cortisone", it really can mean any number of corticosteroid medications, and there are many. The one you referred to is of a rather low potency, and tends to have effects that are not as long lasting. However, your doctor will chose what he/she feels is best for you, and what works best in his hands. Regarding a night boot, I'm not really sure I know what you are referring to. I do not use anything like that to treat neuromas. A night splint is used with some success in treating plantar fasciitis (a common cause of heel pain), but I doubt that would have any benefits in the treatment of neuromas.

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  57. This comment has been removed by the author.

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  58. I’m 30 and have had some issues with my flat left foot and would like to quickly run through the history in case it helps.

    Last summer I experienced chronic ankle pain after mild trauma. The doctor diagnosed me with sinus tarsi syndrome and prescribed orthotics. That did it and within a few days the pain went away!

    Jump forward to November, I woke up with a tingling nerve near my sinus tarsi. No trauma had occured. The tingling would trigger periodically while walking/standing and generally got better after my feet warmed up. The doctor gave me cortisone and the problem cleared after about 2 days! On the same day the symptoms were diminishing, I got some arterial pulsing (no idea why) just before the 1st toe. That also went away after an extra 2-3 days.

    Now we are in January. I woke up with a tingling between the 1st and 2nd toe. Once again, no trauma and the symptoms are triggered in the same way as the tingling in November. I have the option for cortisone, but want to wait it out. It has been one month now.

    Should I continue to wait? The symptoms have not gotten better in a month. Two cases within two months scares me (at least they are in different locations). What could the cause of all of this be? Is this a neuroma?

    Thank you again.

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    1. While it would be considered unusual to have a neuroma between the first and second toes, it is not unheard of. If that is indeed what the problem is, a cortisone injection could be helpful. It is important to note that there is no problem with having another injection so soon after your last because they are not in the same location. The complications arise when injections are given too frequently in the same location. Good luck!

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    2. Thanks for the response doctor! The podiatrist said I have neuritis and noticed the presence of a benign ganglion/cyst the size of a grain of rice there. He recommended just waiting 6 months and continuing my normal activities. What is the difference between neuritis and neuromas and how they're treated?

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    3. My MRI 4 years ago confirmed an 8mm MN between 3/4- but also a 3-4mm between 2/3. Boo.
      I had surgery to remove the larger. Recovery was quite challenging. Although the pain from the MN is gone- now every plant down of my foot feels like I am stepping on a cotton ball. It is more annoying than painful and some days its subtle, other - more noticeable.
      Now, the one between 2/3 has really been bothering me. It is so sore and tender on the bottom of my foot between the 2/3 metatarsals. I don't recall my first MN being so tender to the touch there- it was more internal sharp -cramping pain.
      I am going to try the Cortisone before taking on surgery again. My hope is for favorable results.
      Thanks for everyone's feedback, & thank you Dr. for the blog and forum for us MN folks.

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    4. Neuritis simply means the nerve is inflamed, often due to trauma of some sort. Treatment is similar, including injections, immobilization and physical therapy.

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    5. Thanks, I really appreciate your insights.

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  59. I've had pf since October and im now getting a steriod injection in two weeks. I am over weight will this affect how long I should rest it for. I work part time but am on my feet alot thankyou

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    1. I do not instruct my patients to limit activity after injections. The concern is that the plantar fascia will be weakened and rupture after an injection, but at least for me and my patients, this has not been an issue.

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  60. 55 yr old female. My podiatrist is giving me three cortisone injections, one every 3 weeks, for MN. I have had two so far three weeks apart. After reading this blog, I am concerned about the frequency of the shots. I didn't experience much change after the first injection. I just had the 2nd injection three days ago. What is the reasoning for giving the shots so close together?. I guess I should have asked the dr. I just assumed it was to try to get the inflamation down. The dr did say that he doesn't generally give more than 3 shots. I have also added Superfeet orthotics to my tennis shoes, but not yet to my work shoes. My MN history: I have felt the "bunched up sock" feeling on the ball of the foot for about a year. Sometimes that is my only symptom, sometimes I get the tingling, pains and throbbing to the point of sleep interruption. I'm beginning to think maybe I shouldn't have that third shot in a couple of weeks? Any suggestions? I want to take appropiate action now to hopefully keep it from worsening.

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    1. It's hard for me to answer your question without knowing the specific medication your doctor has been injecting into your foot. Some doctors use a non-soluble preparation, which tends to stay put and have longer acting affects. This is what I use. It does have a higher risk of complication if over-used. Soluble steroid injections dissipate quickly, and can be given more frequently without complication.

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  61. I have had a neuroma in my left foot for about 4 years. I have had probably 6 cortisone injections. The shots work for about 3 months and then all the pain comes back. Last summer I had 2 injections and wore a boot for 10 days. Within 3-4 months the pain came back. Its now been almost 8 months and I am limping every day. I walk in pain everyday and my foot sometimes swells to the point that my shoes feel tight. I haven't gone back only because of financial reasons. I do have an appt in 3 weeks, last time I saw him he said surgery was the next step. At this point, anything that will help me walk normal again is a blessing. I walk on my heel to avoid the front of my foot, I get shooting electrical feeling thru the end of my toes and I can't even walk at a normal pace anymore. Do I sound like a surgical candidate?

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    1. Yes, I agree with your doctor. No one wants surgery. It's always preferable to successfully treat problems conservatively. However, no treatment is successful 100% of the time. In my opinion, it sounds like you have given conservative care every chance to work. Can your doctor guarantee a perfect outcome with surgery? Of course not. However, most people who have surgery to remove a neuroma are satisfied with the results. Good luck!

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  62. 55 yr old female here again from Feb 23, 2014 post. I couldn't get the reply to work, so am adding a new comment. The injection is showing up on the bill as Triamcinolone, 10 Mg Injection and Dexamethasone, 1 Mg Injection. Thank you so much for your prompt response. Take care,

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  63. 55 yr old female again, I found further information, the medicine was 10 mg injection of triamcinolone acetonide and 1 mg injection of dexamethasone sodium. Thanks,

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  64. Had steroid injection Thursday and two days later pain started. I'd been mostly pain free for the last several months as I waited for appointment. Now I'm limping and trying to stay off the ball of my foot, as it's hurting like it had been over the summer when I was on my feet a lot. Is this unusual to have pain start rather than subside. And does it take this long for the injection to kick in?

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    1. Typically it takes 2-4 days for the benefits of the injection to be realized. Pain following an injection is not that common, but can occur. It sounds like you're experiencing what is called a steroid flare. This is temporary inflammation and pain following a cortisone injection. It is not very common. I would recommend rest, icing the area, and possibly taking an anti-inflammatory medication such as ibuprofen until symptoms subside. If symptoms continue, let your doctor know.

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  65. Hi Doctor
    In your case, do you know what caused your neuroma? Did it suddenly appear one day without a gradual increase in symptoms? Do you fear it might come back (especially if you don't know what caused it)?

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    1. Good questions! I really don't know specifically what caused my neuroma, and that is often the case. It is believed that they are often caused by trauma - usually repetitive - so their is often no one incident that you can look back on and know what the cause was.

      My symptoms gradually increased over the period of a few weeks. By the time I decided to give myself an injection, the pain was moderately severe, causing me to alter the way I walked to keep pressure off of my forefoot. This is not good advertising for a podiatrist! Do I fear it may return? If it does, I will deal with it when it happens. In my case, enough time has passed that I really don't think about it much these days, except when I am reading and writing comments on this blog. Certainly if my symptoms do return, I will let everyone here know.

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  66. Just had an injection. Was a bit nippy but certainly tolerable, especially compared to the pain of climbing and mountain walking on the mortons neuroma. Surely if the injection is well sited in and around the nerve then a bit of pain is to be expected during injection! So my question is: as someone who has been rock climbing at a reasonably high level, and doesn't want to give up on the advantage of tight rock shoes - is this injection going to help, is anything going to help? It's just you can' stand confidently on match-stick edges when climbing with board lasted rock shoes with your foot and toes straight. You need to have a bit of tension, not painful (except for the neuroma) but tight enough to keep toes in a flexed position without movement of the foot inside the shoe. I really don't want to give climbing up!!!

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    1. Great question Jimmy. I have to admit, I have not had the opportunity to treat many climbers. However, I think there is hope for you. The injection should decrease inflammation, and may also cause some atrophy to the neuroma itself. That should give you some relief from your symptoms. Hard to say for you or anyone if your symptoms will come back. If they do, you and your doctor will have to decide what the best course of action to take. And in some cases, surgery is the best option. Obviously, changing shoes for you is not a viable option, nor is wearing orthotics, as they won't fit into your climbing shoes. I would be interested in hearing how things go for you in the coming weeks and months.

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  67. I developed a pain under left ball of my left foot 2 weeks ago, I have been icing and using advil during that time. It is better than it was but I still have some discomfort. I am going on a golf trip in less than 3 weeks that will require me to walk no carts. Should I continue conservative treatment or other?

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    1. It's hard to know how to answer your question without seeing you. Only you know how much pain you're experiencing. If you feel like you can golf with the symptoms at their current level, then I would continue with the conservative treatments you have already begun. If you think your foot pain will be a problem on your trip, then it's probably a good idea to see a podiatrist before you go.

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  68. My doctor told me that the tingling in my foot (in a location where I thought it was a Neuroma) wasn't due to an issue in my foot, but rather irritation of my sciatic nerve somewhere in my hamstrings. This was is case because i could trigger the symptoms in certain sitting positions that did not place pressure on my foot. I also discovered that it was possible to have irritation in one part of the body and have the pain appear in a different part, making it much harder to diagnose the cause. Anyhow, do you commonly run into these situations?

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    1. From time to time, I see patients with foot symptoms that are a result of problems further up the leg or in the back. This does make the diagnosis a bit more challenging. In my case, since I am a podiatrist and am best at treating foot pathology, if I feel that that the foot symptoms are due to pain referred from other parts of the body, I will refer the patient to a specialist I feel is best able to treat the cause.

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  69. Two years ago I began to feel pain on the bottom of my foot that felt like I was stepping on a rock. I saw a podiatrist and he said I had a MN. He prescribed cortizone shots and orthotics. He gave me a series of 5 shots every 7 days for 5 weeks and PT on top of it all. The shots only lasted a short time and over a period of about 6 months I developed searing pain in my R heal, doc said this time it was something different....Plantar Fasciitis. I told him the orthotics hurt my feet, but he insisted I keep wearing them and it was something different. After a year and a half of PT he recommended surgery. Did a full fasciotomy that never healed and then I developed more pain on the outside of my foot and total numbness on my heal. He then said it was something else and I needed to do a nerve test. I finally went for a second opinion to a orthopedic foot surgeon (should have done that first) and he said the hard orthotics was probably causing my initial pain and the surgery caused me to develop Lateral Column Syndrome. He prescribed a soft orthotic to lift the R side of my foot and a soft pad on the neuroma and said there wasn't more that could be done because I did not have any fasciitis left causing all the weight to go to the outside of my foot....causing the pain. On top of all of this my MN was overlooked for two years and it still causes me so much pain. At this time I am afraid to go back and have any more done to my feet. I live in constant pain, can't walk barefoot at all, wear expensive shoes with good arches that fit the orthotics. I wake up with stiff sore feet and am limited to the amount of activity I can bear. The surgeon did offer another cortizone shot, but I have yet to try that route again.

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