Question
Dear Dr. Tsatsos, I am 59 years of age. I have been an avid high mountain hicker for 24 years, having scaled the likes of Aconcagua (6980m) and Cotopaxi (5897m). High mountain hicking involves 8-12 hour walks in often steep slopes and rough, rocky terrain. It is a repetitive, often intense, low impact activity. In 2009 I stopped mountain hicking due to the appearance of a Morton's Neuroma in my right foot (between 3rd and 4th). It is currently 6mm x 3mm in size. Given that I have flat feet, I use corrective orthopedic supports that allow me to walk comfortably for endless hours inspite of the neuroma, but I can no longer walk on steep slopes for periods longer than 2 hours. After about 2 hours I start to feel the swelling of the affected nerve. After about 4 hours into the ascent the nerve inflammation is considerable.

I have not mountain hicked for 4 years now. I miss the mountain air. I miss my friends........ Its been difficult. In 2011 I had one shot of corticosteroid but it did not help when tested on a long steep trail. The traumatologist suggested a second shot but I frowned on the idea. I had my second shot a couple of months ago mostly out of curiosity - It did not help either. I don't want to go beyong 2 shot as I was told that the stuff can melt your cartilage if you abuse. I have not wanted to have a neurectomy (neuroma excision) because I was told that when you cut the nerve it will attempt to regenerate, and in this process a stump neuroma will form, which is often more painful than the original neuroma.

Are there any alternatives that you can recommend (surgical or non-surgical)? I would love to continue mountain hicking while I am still in good physical condition.

Answer
Dear Samuel,

This Orthopedic Chicago Podiatrist located in West Loop 60661,Roscoe Village 60618, Elmhurst 60126 & Bartlett 60103 says...
You may not have a neuroma.You may have an irritation of the joint(s)-known as metatarsalgia- near the nerve. Did the traumatologist reproduce the exact pain of a shooting sensation radiating between the toes- Mulder's sign. Did he check the sensation between the toes? A neuroma has neurologic findings. Ask him about them. An MRI can be mis-read as a neuroma.
An in depth hands on exam is better than any test, with a physician who has experience. An ultrasound may be better-since the doctor performing can do live & manipulate the foot and probe to aid in diagnosis.
Go see someone else for an opinion-Seek an orthopedic foot specialist.
The stump neuroma is usually due to poor surgical technique-not all surgeons are great surgeons. You won't need to worry if you can find a Board Certified Podiatrist.po
Hope this Helps & Good Luck!
The Chicago Podiatrists of AnkleNFootCenters.com are specialists in orthopedics and sports medicine.
We are located in Chicago & Elmhurst

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661


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