Question
The neuroma between my 2nd and 3rd toes was removed eight years ago.  It has never been completely pain-free since the operation.  However, I managed the discomfort with orthodics and a reduction in weight-bearing exercises.  Because of a period of increased walking that caused increasing pain, I went to a podiatrist in July (2010)who said I may have a neuroma stump between the 2nd and 3rd toes in addition to a new neuroma between my 3rd and 4th toes.  She gave me a cortisone shot first in the new suspected neuroma and then a week later she injected the old neuroma surgical site with cortisone.  The second shot seemed to trigger increased pain and nerve hyper-sensitivity almost immediately, including the feeling of stabbing shooting pains in my toes.  The whole foot began feeling numb off and on.  An MRI test, an EMG test by a neurologist, and an ultra-sound followed.  The neurologist told me I had some mild neuropathy in both feet.  The MRI saw a small cyst in the old neuroma scar area (which my podiatrist dismissed as the cause of my pain) and the ultra-sound confirmed the new neuroma.  However, the ultra-sound test did not detect a neuroma stump; the technician said the stump could be "hiding" behind the scar tissue created by the surgery.  I reduced the amount of walking I do to a bare minimum---to the point that I have trouble walking naturally (and, of course, other feet problems emerge when walking becomes distorted).  Right now, physical therapy is being tried for both the neuroma, possible neuroma stump and neuropathy.  The therapy includes: kinesio taping, laser treatments, deep massage to my lower legs and feet.  I have been told to subject my feet to touching (rubbing with a towel, for instance) so that they do not become too sensitive.  Icing them helps with the pain in the old surgical site, but, of course, it also reduces the circulation.  I feel like I need good circulation for healing and it is hard to keep my feet warm.  I am looking for your suggestions to treat this old neuroma surgical site (which either has a neuroma stump or has scar tissue that has become inflamed and may be pressing on a nerve).. Would I be a candidate for cyro surgery?  Is some other type of surgery appropriate?  Should the painful area be iced?  Should it be massaged? The physical therapy sometimes seem to increase the pain and other sensations I feel, but I have told that it may get worse before it gets better with laser, kinesio taping and massage.  Limited (and often painful) walking has curtailed my life.  Any suggestions for treating this problem would be greatly appreciated.  Thank you so much for giving your time to people like me.

Answer
Hi Eve,

Stump neuroma can be hard to detect on MRI or ultrasound but you may want someone else to look at the actual MRI and ultrasound to get another opinion.  The cyst on the MRI may be from the injection or reaction to the injection.  Ice does help and only temporarily decreases circulation.  After the ice is removed you actually get increased blood flow to the area as the area warms.

While I do believe that physical therapy may help short term, you seem to be having life changing pain.  In that case, I would consider cryosurgery or traditional surgery.  These are your best options.  Cryosurgery can be used for stump neuroma but I am unable to know if you are a candidate without seeing you for an exam.

Good Luck.

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
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