Nerve Disorders
Neuroma
CAUSES
A neuroma is the swelling of a nerve that is a result of continuous compression or trauma most commonly from hard soled or narrow shoes. Other causes include flatfeet and bunions altering the way you walk. The pain can be described as burning, tingling or cramping with occasional shooting and numbness into the toes. Also people will describe this as walking on a pebble or having their sock bunched up. Most notably the affected toes will begin to separate causing a V-sign between the toes.
DIAGNOSIS
Diagnosis is made by squeezing the foot from the sides eliciting pain and pushing on the neuroma where a palpable click can be felt. We also use diagnostic ultrasound to determine the size and thickness of the neuroma. X-rays will not show a neuroma but are useful to rule out biomechanical abnormalities, stress fractures, arthritis or plantar plate ruptures that can mimic a neuroma.
TREATMENT
Conservative treatment consists of steroid injections, padding and arch supports which can help to alleviate the symptoms for up to 80% of the patients. However in the remaining 20% of patients that require surgery most surgeons will recommend a surgical procedure to remove the nerve which will keep you off work for 6-8 weeks and activities for up to 3 months. Also the post-operative complications can lead to a muscular imbalance and a possible stump neuroma which will require an additional surgery.
At Mid-Ohio Foot and Ankle we specialize in the percutaneous decompression with cryoablation of the nerve through a 5mm incision. This procedure can be done in the office under a local anesthesic to numb the toes instead of putting the patient to sleep at the hospital or surgery center. You are walking the same day and back in a shoe within a week. This leads to minimal down time and minimal risks of complications. We have a 95% success rate utilizing this procedure over the last 10 years.
Neuropathy
CAUSES
Most commonly associated with diabetes other known causes include alcohol abuse, back issues causing nerve impingement or idiopathic, meaning no known reason why the condition persists.
With prolonged damage to the nerve from increase blood sugars, alcoholic degradation of the nerve covering or unknown reasons the nerve begins to fire improperly thereby sending the wrong messages and symptoms to begin to occur.
DIAGNOSIS
Special tests such as a nerve conduction velocity test can detect impingement syndromes throughout the lower back and legs causing the symptoms. Once the symptoms begin a punch biopsy known as an epidermal nerve fiber density test can be performed in the office to detect the degree of degradation of the nerve endings.
TREATMENT
Treatment depends on the severity of the symptoms and can begin by modifying your diet to lower blood sugars which will decrease the severity of the neuritis as your HgBA1c lowers over time. Also vitamin b12 supplements can be very helpful in decreasing the symptoms by taking either oral pills or vitamin b12 shots monthly given in our office. Laser therapy performed in our office at weekly intervals has also been shown to decrease the severity of the symptoms within a few weeks. The worst cases may require a surgical decompression of the nerve.
