Question
Dr. Katz,

4 months ago I was running when I side-stepped a puddle and felt a slight tweaking pain, which developed into almost complete numbness in the following 20 minutes.  X-rays a week and 4 weeks after the injury ruled out stress fracture.  One ortho surgeon said metatarsalgia; another at 8 weeks said Morton's Neuroma (he diagnosed w/ lidocaine injection-- made the spot feel like I had a huge numb lump-- and + lateral squeeze test).  Cortisol shot helped for a few weeks, but now the symptoms are back and different than before.  Any time I get stressed about something I lose complete sensation in the affected foot (sort of like when one's foot falls asleep).  My foot itself doesn't hurt most of the time, except when I step on it-- feels like walking on a bruise.  Constant calf pain is present though, and everything from the calf on downwards ALWAYS feels super cold and swollen-- I can feel an immediate difference after taking off socks.

I'm not sure if metatarsal pads are helping at all, and NSAIDS simply numb the pain and taking it just causes me to over use my foot as I can't feel the warning signs.  I'm hesitant about surgery given potential complications (20% get painful stump neuromas, and 20% report no relief?).  I feel like I've hit a plateau in my recovery in the last 2 months and am getting really frustrated-- I'm in my 20s and my life revolved around a super active style, all of which I can't do anymore.  I live in a city most of te time, so not walking is near impossible (and even driving aggravates it, since it's my right foot!)  My ortho surgeon poo-pooed multiple steroid shots (fat pad loss), alcohol sclerosing injections, and said there was no physical therapy I could do.   

Any thoughts?  I'd like to hear whether you think this is consistant w/ MN, and whether you have any other suggestions for conservative treatment, or thoughts on surgery.

Thanks,
Min

Answer
Hi Min,

Some of the symptoms you describe sound like Morton's neuroma.  However, constant calf pain, cold and swelling is a concern that is likely not related to a neuroma.  I would consider seeing a neurologist to make sure that you have not developed a problems known as CRPS.  This is a nerve condition that can cause some of the symptoms that you have in the leg.  I would consider a venous doppler to make sure that you have no blood clots in the painful leg.  You may indeed have a neuroma but I would check these first.

For a neuroma I would check into custom orthotic devices.  I would see a podiatrist, not an orthopedic surgeon.  There are other options instead of the typical surgery.  My favorite is cryosurgery.  You can take a look at my site for information.
http://www.tampacryosurgery.com

Good Luck.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com


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