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.

136 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:-)

    ReplyDelete
  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!

    ReplyDelete
    Replies
    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.

      Delete
  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.

    ReplyDelete
  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?

    ReplyDelete
  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!

    ReplyDelete
  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

    ReplyDelete
  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.

    ReplyDelete
  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.

    ReplyDelete
  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. :)

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

    ReplyDelete
    Replies
    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.

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

    ReplyDelete
    Replies
    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.

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

    ReplyDelete
  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.

    ReplyDelete
  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.

    ReplyDelete
  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.

    ReplyDelete
  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.

    ReplyDelete
    Replies
    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.

      Delete
  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

    ReplyDelete
  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.

    ReplyDelete
  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.

    ReplyDelete
    Replies
    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.

      Delete
  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 :)

    ReplyDelete
  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.

    ReplyDelete
  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 :(

    ReplyDelete
    Replies
    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.

      Delete
  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?

    ReplyDelete
  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).

    ReplyDelete
  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.

    ReplyDelete
  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.

    ReplyDelete
  27. Very helpful, thank you.

    ReplyDelete
  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.

    ReplyDelete
  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..

    ReplyDelete
  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?

    ReplyDelete
  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.

    ReplyDelete
  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?

    ReplyDelete
  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?

    ReplyDelete
  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....)

    ReplyDelete
  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.

    ReplyDelete
  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. :(

    ReplyDelete
  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.

    ReplyDelete
  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?

    ReplyDelete
  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).

    ReplyDelete
  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!

    ReplyDelete
    Replies
    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.

      Delete
    2. I was diagnosed with MN in both feet 12 months ago and have not been able to go back to the gym. Walking seems to be the only thing that does not aggravate the MN's. I have had cortisone inj in both feet and am very happy with the results up until a week ago when the inflammation (puffiness) has returned so looks like I will be off to the docs to org a 2nd round of injections.

      Delete
  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.

    ReplyDelete
  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!

    ReplyDelete
  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.

    ReplyDelete
  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

    ReplyDelete
  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.

    ReplyDelete
  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?

    ReplyDelete
  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.

    ReplyDelete
  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!!!

    ReplyDelete
  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....

    ReplyDelete
  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.

    ReplyDelete
  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!!!

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

    ReplyDelete
  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.

    ReplyDelete
  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!

    ReplyDelete
    Replies
    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!

      Delete
  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 .

    ReplyDelete
    Replies
    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.

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

    ReplyDelete
    Replies
    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.

      Delete
  57. This comment has been removed by the author.

    ReplyDelete
  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.

    ReplyDelete
    Replies
    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!

      Delete
    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?

      Delete
    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.

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

      Delete
    5. Thanks, I really appreciate your insights.

      Delete
  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

    ReplyDelete
    Replies
    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.

      Delete
  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.

    ReplyDelete
    Replies
    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.

      Delete
  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?

    ReplyDelete
    Replies
    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!

      Delete
  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,

    ReplyDelete
  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,

    ReplyDelete
  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?

    ReplyDelete
    Replies
    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.

      Delete
  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)?

    ReplyDelete
    Replies
    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.

      Delete
  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!!!

    ReplyDelete
    Replies
    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.

      Delete
  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?

    ReplyDelete
    Replies
    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.

      Delete
  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?

    ReplyDelete
    Replies
    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.

      Delete
  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.

    ReplyDelete
    Replies
    1. It sounds like you have really been through a lot. It's frustrating when you seek treatment and don't get better. Before you make generalizations regarding podiatrists, remember that every single doctor that has ever practiced has some patients that fail to respond to treatment. And I would also say that every doctor has patients that are not happy with the care they received from them. For instance, just today I saw a patient who was very unhappy with a foot surgery that she received from an orthopedic surgeon. And I'm sure that that orthopedic surgeon has seen patients who were not happy with me. Hopefully going forward, you will find the right doctor and treatments that will succeed in resolving your pain.

      Delete
  70. So after nearly a year Dr. Quist, how is it doing? Do you do any sports? I am a runner/triathlete who is going for my first injection this Friday. I had a disastrous marathon about ten days ago, and my middle toe is still completely numb. Have not run since then. Does the current numbness have any bearing on the injection?

    ReplyDelete
    Replies
    1. I have been fortunate that my symptoms have not returned since I injected myself. Hopefully, that will continue.

      I don't think the presence of numbness has any bearing on whether or not you receive an injection. Let me know how you do!

      Delete
  71. I have MN in both feet for the last 3 months. I like running & can't do that at the moment because the pain is too bad. I have had orthotic insoles fitted which haven't really made any difference. My Doctor gave me naproxen only a week ago, which haven't helped either. Both my feet are swollen & very painful whatever footwear I wear. Can I go & ask for injections?

    ReplyDelete
    Replies
    1. If the diagnosis is correct, I think and injection would be the next logical step. Sometimes, when patients are either apprehensive about an injection, or are concerned about the cost, I recommend trying just one foot first. Then, if the injection was successful, the second foot can be injected a few weeks later.

      Delete
  72. I have had a MN in left foot for some time. I saw a podiatrist and he started with lidocaine injections I did 2, 2 weeks apart not much relief. Orthodics were made and I wear tennis shoes quite often now. Now it is much worse. It is leading to other heel pain etc. I finally went back after some time (painful everyday, just dealt with it... ) and this time I did 4 treatment 2 weeks apart. It feels like it gets pushed up,and I have to curl my toes to relieve this, and when it pops, it burns. Now he is talking surgery to remove it. Should I do surgery before trying the cortisone injection though? After what I am reading it seems like I should have just tried that in the beginning. It was not offered.

    ReplyDelete
    Replies
    1. Congratulations abetterme, you were the 100th comment on this blog post! No prize other than personal satisfaction though. ;-)

      In regards to your question, I personally do not feel a lidocaine injection would provide any long-term relief other than giving pain relief for the few hours that the area stays numb. Lidocaine is a local anesthetic. There are times when giving an injection to a certain location can help in making a diagnosis, but I don't think it would be therapeutic. I think trying a cortisone injection would be a good idea before surgery. I like to try less invasive treatment options before more invasive ones. To me, a cortisone injection is less invasive, and has a much lower rate of possible complications. That's not to say that surgery does not have a place in the treatment of this condition - it most certainly does. I just think you're better off exhausting all your conservative options first. Good luck!

      Delete
  73. I just had a steroid shot 2 days ago diagnosed with MN on left foot and pain is not as bad but not completely gone. How long does it take for pain to go away after the shot? I have read through your blogs that have been so helpful, btw and thank you. and you have mentioned it takes only 2-3 days to see results and today is my 2nd day. If my pain does not go away completely after 3 days, is that a bad sign? the super sharp episodes of pain are totally gone but it still has pain when i try to walk normally. And Im waiting for my podiatrist to get prior auth from my insurance on orthotic/insert that was recommended and it may be a few wks before I actually get it. In the meantime, what kind of cardio activity can I do since I'm missing my treadmill/elliptical. Can I go on the stationary bike? He had recommended New Balance, Asics or Brooks for walking shoes, do you agree with that? He advised to avoid wearing my Nike since its narrow- and this really has been my culprit, no offense to Nike. And with swimming, I usually use fins for lower body workout. Is it safe to do with MN? Looking forward to your much appreciated professional opinion.

    ReplyDelete
    Replies
    1. Rowena,

      Hopefully by now you have more relief of your neuroma symptoms. As you mentioned, it can take a few days (sometimes even up to a week) for the injection to relieve symptoms from a painful neuroma. Unfortunately, sometimes the injections do not work. In that case, other treatment options should be explored with your doctor. In regards to what shoes to wear and what activities you may participate in, your foot will tell you if your doing something that is potentially harmful in that you will experience pain. I would think bike riding though would be an excellent activity, especially If you do not put your forefoot on the pedal. Regarding numbness in the toes, this is often a symptom associated with a neuroma. Hopefully with treatment, that will go away. Good luck!

      Delete
  74. Also still have some tingling sensation on my toes occasionally....same sensation with your foot is asleep.

    ReplyDelete
  75. Who am I best to see to have the cortisone injection administered from?

    ReplyDelete
    Replies
    1. The best person to see if you have a neuroma is someone who has experience treating this condition. What's hard is that you'll likely have a hard time finding out that information.

      To be upfront, I must tell you that as a podiatrist, I am undoubtedly biased. In my experience though, most family practice doctors will not attempt to treat this condition on their own, and will refer to a specialist. That is not to say that there are not family practice doctors who have an interest and skill in the treatment of neuromas. The other type of doctor who might treat this condition would be an orthopedic surgeon. While they have excellent training, it's hard to know how much of that training was spent on hips, knees, etc. and how much was devoted to treating foot conditions. There are orthopedists who specialize in the foot through fellowship training. If you find one of these doctors, he/she may be a good option for you.

      Finally, you could see a podiatrist. A podiatrist is a doctor who specializes in the treatment of conditions related to the foot and ankle. We see a lot of feet! By sheer volume, I think we as a profession become very successful in treating many conditions of the foot and ankle (including neuromas). Certainly, as in all professions, there are some podiatrists who are more proficient than others. I would start if you're not sure which way to turn by asking your family doctor who he or she which podiatrist he/she would recommend, as he/she will have a better idea of who practices in your community.

      For more information regarding podiatry, and what a podiatrist is, I invite you to check out the website of the American Podiatric Medical Association (APMA). There is also a tool that will help you find podiatrists who are close to you who are members of the APMA.

      http://www.apma.org/learn/content.cfm?ItemNumber=992&navItemNumber=558

      Good luck!

      Delete
  76. I have been dealing with MN in both feet for over a year. Tried orthotics, but was also having plantar fasciitis at the same time and they hurt my feet worse! The my podiatrist and I tried cortisone injections. They lasted a few months, then the MNs came back full force. Next we tried 5-7 alcohol injections in each foot. Finished up last Dec. ('13) and thought they had worked. In April, they returned even worse. Just saw an orthopaedic surgeon last Wed. who specializes in foot and ankle and he tried 2 more injections of cortisone. Felt great for a day or two, then back to what feels like "walking on golf balls" on the ball of my feet. If it's going to work, won't cortisone relieve the pain in several days? I am ready to have surgery, but have had to wait because I'm on Plavix. Hope everyone gets some relief soon...we all are in a rocking boat!

    ReplyDelete
    Replies
    1. A couple of thoughts on your situation...

      First, orthotics should make your plantar fasciitis feel better. If that's not the case, perhaps the orthotics should be adjusted or re-made.

      Second, if a cortisone injection is successful, pain relief will last for varying amounts of time (weeks to months). Your relief for a day or two was probably not from the cortisone injected, but rather from the local anesthetic that was likely injected into the foot at the same time.

      Third, it does sound like you are ready for surgery. Hopefully, this will be the end of the road for your neuroma symptoms!

      Delete
  77. Hello,

    If surgery is needed do you need to stay off your feet? I rather not miss any work. Thanks

    ReplyDelete
    Replies
    1. Yes, if you have surgery, you will need to "take it easy" for at least a few weeks, perhaps longer, depending on the type of work you perform. For people who work sitting at a desk, it's possible to return to work much more quickly, perhaps in a week or so. For more strenuous jobs, it's best to plan for the worst. It's very frustrating to be scheduled to return to work and not have a foot that is still painful.

      To be clear, after neuroma surgery, a person can walk. You'll likely be placed in a post-operative shoe. However, being able to walk (such as around the house) is not the same as going back to work. To be safe, have this discussion with your doctor before your surgery is planned so he/she can tell you what would be an appropriate time to be off of work. Good luck!

      Delete
  78. I'm due steroid treatment in my left foot for the neuroma,im a postlady how soon can i start for walking for 4hrs a day?

    ReplyDelete
    Replies
    1. That question is impossible to answer for your specific situation, as ever person reacts differently to the treatment. If you respond well to the injection, you should be able to start walking within the first few days following treatment. However, I would advise starting slow and easy, gradually increasing your speed and distance as your symptoms (or lack thereof) allow.

      Delete
  79. I've had 3 shots so far for my neuroma and not working causing burning pain in some of my toes. The next step would be alcohol shots. What is your opinion on the alcohol shots. My understanding there is a series of approx. 4-7 shots over a number of weeks.

    ReplyDelete
    Replies
    1. I have used the alcohol injections in the past, but my success rate was not high enough for me to continue. I'm sure there are others who do have success, but I was not one of them. They are safe, so the downside is minimal. It would be good to check with your insurance before you begin to verify coverage for this procedure - it is not universally covered, and can be a bit expensive.

      Delete
  80. What percentage of your patients with MN get only one steroid shot and that takes care of the problem permanently? I got a shot 2 days ago and there is barely any pain anymore. I feel like its too good to be true after 9 months of chronic dull pain!!! Also can turf toe cause MN and if so, by what mechanism?

    ReplyDelete
    Replies
    1. I'm not sure I can give you an absolute percentage as you asked, but I will say that most people see significant relief for a period of time - and that period can vary greatly from weeks to months to occasionally years. It's important not to put your foot back into tight shoes, because that will likely aggravate the neuroma and possibly lead to symptoms returning sooner.

      Delete
  81. I had a cortisone shot on friday afternoon. Now it's Tuesday evening and symptoms seem worse. Should I be worried?

    ReplyDelete
    Replies
    1. Anytime symptoms get worse, it's best to give your doctor a call so you can find out what's going on. Any guesses as to what's going on from me would just be guesses. However, one possibility is that you're experiencing what is termed a steroid flare (which has been discussed previously in this comment section). My advise is that if you're still having pain in the morning, go see your doctor, then you won't have to wonder what's going on - you'll likely know and have information as to what can be done to improve your symptoms. Good luck!

      Delete
  82. Dr. Quist .......my Podiatrist has decided that the cortisone injections he administered were ineffective, and that we might need to look at surgery. He believes I have a neuroma in each foot. Before he does the surgery, how does he confirm that I actually do have a neuroma? Thanks.

    ReplyDelete
    Replies
    1. Most of the time, a neuroma can be diagnosed by examination of your doctor. Ultrasound and/or MRI can also be helpful in the diagnosis, but are not perfect. I would trust your doctor in this case, since this is something most of us see on a regular basis, and are able to diagnose with a high degree of certainty.

      Delete
  83. Hi I've had pain for awhile went to a foot doctor been wearing a boot over a about a month in a half. Also have had i think its electrical signal therapy. I had that 7 times twice a week with the last visit I felt a burning so we didn't continue the treatment. I seen my doc today and he gave me a cortisone shot on the top of my foot by my second and third toes. She first sprayed my foot to make it cold then injected my foot. Then about half way though, I had such a bad sensation it was from the ball of my foot to my toes. Sort of felt like my foot exploded like a pop, and also it felt like I stuck my food in a fire. Of courts it hurt. I moved my foot then she said something about her being n the nerve. Idk. Anyway then she finished. I have had the shots before for heel spurs and that was nothing to what I felt. At first it wasn't so bad then what. What was that. I wax being treated for a neuroma . I first was being treated for a tear in my planter plate and a tear in my capsule. I know its pulling my toe to one side. What I want to know was what was the pain I felt to where it felt like my foot exploded for a few seconds? Thank your so much. My name is Kristie I'm a 39 year old female,

    ReplyDelete
    Replies
    1. Kristie,

      I am pretty sure what happened is that the needle went into the never itself. I know from experience what this feels like. When I was in school, we spent one week (I think it was my second year) learning how to give injections. How did we learn? We gave injections to each other. On one of the injections, my fellow student hit the posterior tibial nerve (which runs along the inside of the ankle, just under the ankle bone). Anyway, when he hit my nerve, it felt like instant fire. My leg jerked back, and the needle and syringe flew across the room! My foot was sore fore several weeks after that. You can be comforted though that the nerve where the neuroma is located is much smaller and it is rather rare to hit it as yours appears to have been hit. And while your experience was painful, I would not expect any long-term negative effects from the incident.

      How is your foot feeling now? Did the injection help your symptoms?

      Delete
    2. Hi, and thank you for getting back to me. Actually no it hasn't helped. Actually I have had more pain in my toes and more pain on the bottom of my foot. I also noticed the popping sensations from the nerves are more also. I have the mn problem plus a tear on my planter plate and capsule the doctor said from my MRI. I've been wearing a boot for almost 2 months now with no change. Should I be feeling some relief by now?

      Delete
    3. Yes, you should be seeing some relief in your symptoms by this time. You need to go back to your doctor and explore other options, which may include surgery. A second opinion might be in order if you're not satisfied with the treatment received from current doctor. Sometimes, it just helps to have a fresh set of eyes review your condition. Good luck!

      Delete
  84. Got injected on top of foot where it normally hurts today and when I left office, the whole OPPOSITE side was aching more than the other side EVER did before. They already did two shots in same foot today, should I go back tomorrow for one more? Will they do three in one foot in two days? Going to costa rica in 4 days, need to be able to walk!

    ReplyDelete
  85. Aww crap. I don't have MN, I have a cyst of some kind, sorry.

    ReplyDelete
  86. I was diagnosed with MN between my second and third toe and had a steroid injection on the top of my foot. The Doctor took his time administering it and said that he was trying to fan it out so the procedure lasted several minutes. I ended up with a lot of bruising and after 2 weeks I still had a lot of pain from the MN so was not optimistic. However, by the end of the 3rd week the pain subsided and it has been really comfortable now for 4 months. I have found that I haven't been able to go back to ballroom dancing as pushing up through the balls of my feet and onto my toes seems to aggravate it - and the neuroma swells up again.

    ReplyDelete
  87. I had a steroid shot in the top of my foot for Morton's neuroma its been a week now and my foot still hurts the same but now it is very swollen I am supposed to go back to work in 2 days but I can not walk on my foot My Foot itself has been hurting me for over 2 months I finally went to the dr about it she gave me the shot that day a Week later I am worse with swelling

    ReplyDelete
    Replies
    1. If you're still having pain you'll need to go back to your doctor so he/she can determine what the problem is. Hope things are improving for you!

      Delete
  88. Dr. Quest....I had two steroid shots, one in each foot. No pain what so ever but also not effective. Now my doc is suggesting alcohol injections (8-10) to kill the nerve before we consider surgery. I read so many horror stories as far as the shots and the surgery. Just like I read how painful the steroid shots were....which they were not. What are your views on the alcohol injections?

    ReplyDelete
    Replies
    1. I have done the alcohol injections in the past, but I no longer do them. Patients tend to find them a little more painful than cortisone injections. While I did have success with some patients, it was not consistent enough in my hands to make me want to continue performing them. If your doctor is comfortable with them, it is something that can work and potentially help you avoid surgery. It's important to note that the alcohol injections, if successful, will kill the nerve and leave the adjacent toes numb. Of course, surgery has the same effect. Good luck!

      Delete
  89. I've had the problem in my right foot now for about 15 weeks. Initially the first week it was fairly sore, but then it sort of bottomed out at just "uncomfortable" and has stayed really at that level throughout. It flares up slightly from time to time, normally after a hard session. I run 40 miles a week, and most sessions are ok, it tends to be the high intensity speed sessions that flare it up (possibly because I'm running more on my toes?). I don't get a lot of the symptoms I see others with, sharp pains, numb toes etc. Its uncomfortable, it clicks and generally feels like theres some crunching of metatarsals going on. Visible if I stand up with foot flat to floor, and roll my weight outwards to the 3rd 4th toes I see something pop over the gap between 3rd and 4th. Ultrasound diagnoses a mortons neuroma in there (think he said 5mm), and while I was there I had guided cortisone injection into the neruroma. That was last Monday. for the next couple of days it was swollen a little, and I did get pain from it (which I hadn't really had for a few weeks tbh). The injection site itself bruised, so I kind of guess internally it all bruised and that is why it was sore. I'd say overall though the last week it has been worse since the injection than it has in months. Yesterday was probably the best day since injection when it felt ok. In summary though now, I'd say its the same as before. If I roll my foot outward, it clicks and is uncomfortable, rather than pained.

    Apologies for long ramble, but does anything in there stand out? Is it really a mortons neuroma that is causing my trouble? Could it be something else? I don't get a lot of pain and tingle related symptoms, but I do get a click, and the ultrasound did find the neuroma. When he injected it, I felt like over the next few days the typical neuroma symptoms that I'd skipped did come out a lot more...

    ReplyDelete
    Replies
    1. It's hard to say for sure without being able to examine you in person if your symptoms are a result of something other than the neuroma seen on the ultrasound. The fact is, cortisone injections are not always successful. You may want to go back to your doctor and see if another injection might be indicated, or perhaps he will have other treatment options for you, such as orthotics or surgery. Good luck!

      Delete
  90. My podiatrist is advising cortisone injections for Morton's Neuroma in both my feet, however, my family doctor is saying there is a big risk with injections in your feet and is basically advising against it. I am torn as to what to do. Please help me decided what's best for me. Thank you.

    ReplyDelete
    Replies
    1. The question I would ask your family doctor is this: What risks is he referring to? Are those risks more than surgery? If he has a better suggestion for treatment, let's hear it! I frequently give injections for neuromas, and complications are rare. The biggest risk in my mind is that it might not work.

      In my 25 years of practice, I have seen family doctors give opinions on many subjects that they obviously (in my opinion) have no experience in. This is not family practice doctor bashing - I think the vast majority do a wonderful job (I see one my self!). But it's not realistic for them to have expertise and experience in all fields of medicine. I would trust your podiatrist.

      Delete