Dr. Ozer wrote:
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The injections are just as painful as cortisone injections...not fun. It sounds like the neuroma was never removed the first time...I doubt it grew back! The simple cure for this condition would be for the doctor to surgically fracture (osteotomy)one of the metatarsal bones impinging on the problem nerve. This procedure would most likely be much less traumatic than what you went through in having the neurome "removed". A metatarsal osteotomy requires no stitches, pins or screws and you are ambulatory immediately.
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I have had no experience injecting neuromata with alcohol, but clearly neuroma surgery, though highly successful has it's failures for one of several reasons. Although good techniques calls for some gentle tension on the neuroma during excision so that the remaining nerve segment might retract to within the intrinsic musculature of the foot and avoid entrapment by the inevitable scar tissue resultant from any surgical intervention. When so entrapped, pain, similar to that which existed prior to surgery can return, as well as phantom pain in areas distal to the removal. Similarly, the surgical trauma of excising the neuroma can result in a stump neuroma which may also result in similar pain or paresthesias as described above.
Anyone actually familiar with the anatomy of the foot would know that the neuroma is deep to both the metatatarsal head and shaft, as well as proximal to the metatarsal head, and a metatarsal osteotomy, in my opinion is a poor and inappropriate choice for relief of neuroma pain.
If sufficient complaints warrant, post-operative recurrence of neuroma pain should generally be treated by re-exploration of the surgerized area and removal of any scar tissue and or stump neuroma.
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