Question
Hi. I have some follow-up questions.

I recently had an M.R.I. for the neuroma just to see how serious it is. The problem was it wasn't even detected! I was told by people online that M.R.I.'s sometimes miss neuromas, and that size is the key to finding it.

The summary of the M.R.I. was:

1) Small cyst in the soft tissues volar to the 3rd MCP joint.
2) Very unusual pattern of bone marrow edema involving many of the phalanges. Differential considerations are noted above with a major consideration being stress injury.

I抦 guessing they detected this because of intense running I had done several months ago. The extreme running coupled with shoes that were way too small and tight produced the neuroma.

The neuroma may not show but the pain is real. A specialist already diagnosed me with a neuroma, where he squeezed my foot and asked if it hurt (which it did very much). Also, I can't wear shoes (except for sandals) anymore, which was the exact same problem of the patient you treated in your news special. I learnt that cortisone can help confirm a diagnosis but I haven抰 tried cortisone yet because I hear it抯 only temporary.

Would I still be a candidate for cryosurgery even if I have no physical evidence of the neuroma? Is it easier to treat a neuroma that is smaller? Lastly, how does a cryosurgeon know where to place the probe given they have no image?

Thanks,

Jeff


Answer
Hi Jeff,

Great questions.

MRI is a fair tool for detecting a Morton's neuroma.  If the cuts aren't perfect it may be hard to see.  Also, if the Radiologist isn't familiar with the foot they may not ever look or mention neuroma.

The small cyst they mention could indeed be a neuroma.  Volar is the bottom or sole of the foot which is the area of a neuroma.  Typically this is identified as the plantar aspect of the foot.

Personally, if I saw this reading I would call the radiologist or look at the actual MRI films myself.  When they mention a cyst, you could have a cyst hitting the nerve and have similar symptoms of a neuroma, so this must be clarified

However, the most important part of diagnosing a neuroma is the history and exam.  I can tell if you have a neuroma with basic clinical information and exam.  In many cases this will not be seen on MRI.

If you do have a neuroma then Cryo is certainly an option.  How do I find the neuroma.  There are 2 ways.  One is the palpation technique.  This involves finding the most painful area and freezing.  I personally prefer my technique which is more accurate.  I use a nerve stimulator which is at the tip of the Cryo probe.  I am able to precisely identify the nerve and then directly freeze the nerve.  Typically, there will be a burning sensation as the nerve is frozen and within about 45 seconds, numbness is present.  This represents the start of nerve death.  Death in this case is a good thing.  In addition, I am often able to see the nerve using diagnostic ultrasound and can often see the nerve being surrounded by the ice from the probe.

During my news story, I was not using a nerve stimulator and now I have upgraded and will never look back.


Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.fix-my-foot.com

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