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Re: [at-l] Knees and Orthotics



At 04:24 PM 12/23/96 PST, ILFltlndr@aol.com wrote:
>What's a neuroma Mark?  I have used orthodics for my ankle pain.  When I

The neuroma is a growth around the nerve that runs between the metatarsil
bones in the foot, usually between the third and fourth metatarsils.  It is
usually caused by shoes that are too snug.  Basically, the nerve gets
irritated and builds up a mass around itself.  Unfortunately, this only
aggravates the problem.

In my case, I can feel the lump "pop" between my toes.  So far, I've been OK
as long as I religiously avoid shoes that are too snug.

I found the following site on the net.  The text from that site is quoted
below, but the real thing has pictures!

        http://www.medmusic.com/neuroma.html

-- Jim

A thickening of the outer coating of a nerve.
Caused by irritation as the nerve is rubbed by the long bones.


Neuromas are often due to poor shoe fit and abnormal bone movement. The area
between the third and fourth toes is the most commonly affected, however the
area between the second and third toes is also commonly irritated. 

Symptoms


The pain can be described as burning, tingling or cramping with occasional
shooting and numbness in the toes. Symptoms usually occur during or after
walking or standing. 

Evaluation

At the doctor's office you should expect a history and physical and an
examination. The doctor will squeeze your foot while pushing on the neuroma.
He is testing for a "clicking" feeling as he is doing this. This "click"
usually represents a thickened nerve passing between the long bones of your
foot. During this test you may experience a similar tenderness to the pain
you feel when walking or standing. X-rays may be used to rule out other
causes of the pain.

Note: Often with chronic neuroma formation, the toes will spread creating a
"peace sign". This is referred to as Sullivan's sign and is due to the
growing mass pressing on bone and soft tissue. 

Treatment


Nonsurgical:

Orthotics: A shoe insole with special padding designed to support your foot.
The padding should
spread your foot in front which prevents irritation to the nerve.

Shoe Changes: Tight shoes can aggravate this so shoe stretching can be of
great benefit. I reccommend a visit to a board certified Pedorthist. This
person can best handle all shoe related problems and give you the attention
you deserve.

Physical therapy: Usually involved using ultrasound. This is good for very
mild cases where the inflammation is acute. If the nerve is very thick, the
pain may return after therapy is discontinued.

Medication: Cortisone injections or other medication can relieve pain and
swelling.



Bursa vs Neuroma


A bursa is a fluid filled protective sack that the body will form in an attempt
to protect itself from friction. Often, as a neuroma grows, it becomes
inflammed. During this process, a bursa may form around the outer
coating of the nerve. Often it is the bursa that will contribute to the
pain which can be treated effectively with therapy and
cortisone. If, however, the nerve itself has
grown too thick, these treatments will
be less successful and surgery
will be indicated.


Surgical treatment

<Picture>


A local anesthetic may be used for this procedure. The surgery may be performed
in the office if a sterile room is available. Surgery involves removing the
thickened nerve. Following the surgery, you should feel numbness in the area
where the nerve was removed. Patients with painful neuromas gladly accept
this numbness instead of the pain. Usually, you can return to normal
activities in three weeks.

The pain should be permanently relieved.

There are anesthetic options which usually include local with or without an
intravenous supplement to relax you. General anesthesia is usually not used.

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