When I am treating a neuroma for a patient I am trying to quiet down an inflamed nerve that is causing pain. The pain can be severe and often warrants fairly aggressive treatment. Other times the simplest form of treatment is all that is needed. Switching to a wider width shoe and avoiding thick socks can often eliminate symptoms from a neuroma. An open toe shoe or sandal works very well for many people with this problem. This is often done in conjunction with a short course of an anti-inflammatory medicine. If this works but not quite enough, the judicious use of a corticosteroid is often tried. I try to limit the numbers of injections given to 2 or 3. Steroid injections can be very effective in reducing the pain caused by a neuroma. Again, we are talking about a condition in some people that hurts so bad they avoid putting shoes on and have eliminated most of their activity due to the pain. Runners will stop running, dancers stop dancing and workers dread going to work. In these cases the possible benefits from an injection far outweigh possible side effects.
Recently, I have had good results with cryotherapy, the freezing of the affected nerve, which desensitizes the area thus reducing symptoms. Finally, their are those neuromas which do not respond to any of the above and hurt enough that excision is performed. The results of excision are favorable. I do the procedure at either Martha Jefferson Outpatient Surgery Center, Martha Jefferson Hospital or Augusta Health. It is a 20 – 30 minute procedure that is done with a local anesthesia and IV sedation provided by an anesthesiologist. Postoperatively rest and elevation is required for 2 weeks. This is followed by 2 weeks of decreased activity and an open toe shoe or sandal. Once successful treatment of the neuroma has taken place patients will get back to normal activity.
Plantar fasciitis remains one of the most common problems I treat. I see plantar fasciitis in factory workers, teachers, nurses and athletes in great numbers. These, and others, who are on their feet a lot are susceptible to this condition. It is very frustrating to have and can be frustrating to treat. It is technically an overuse injury. The cause is usually multifactorial with the combination of foot structure, activity level, shoes worn, body weight frequently coming into play. Several of the factors contributing to plantar fasciitis can be modified (activity, shoes worn) while others cannot (job requirements, foot structure).
For runners, tennis players, those who do aerobics or other impact weight bearing activity you usually have to take time off from your activity while being treated for this. This is a time to cross train. Swimming, bike riding, rowing machines, lifting weights on machines can usually be continued during treatment.
Shoes worn during treatment should be modified to include running shoes, good work boots or hiking shoes. Shoes worn should have rigid soles with adequate shock absorption. A key ingredient in shoes is a removable liner. We can then put in either a very supportive over the counter orthotic or a custom made functional orthotic into the shoe. This will provide extra support as well as shock absorption. Going barefoot should be avoided as well.
If the change in shoes and inserts do not help more aggressive treatment will be needed. An x-ray will sometimes be taken to rule out a stress fracture. A combination of taping, anti-inflammatories, orthotics, and corticosteroid injections might be needed to quiet the condition down. It can take 6 months to a year for bad cases to respond to treatment. Surgery is only considered when the above have failed to give relief. When surgery is performed I do a partial release of the plantar fascia. This can take several months to heal from. As stated, the procedure is reserved for those not getting better with more conservative care. For those who do need surgery you should know that the procedure works very well.
I had chronic plantar fasciitis in 1990 after the New York City Marathon and ended up being in the small group of patients not responding to care. In 1993 I had a partial release done and have not had problems since. Hopefully, you will not require this level of care but if you do we can help you.
Posted by Kevin Murray, DPM
Patients love our friendly, accommodating team! So, we have decided to feature one of our team members on the blog each month. First, we would like you to meet Amy Estes.
Amy is a Certified Limited Radiology Technician, a Medical Assistant, and our Charlottesville Surgery Scheduler.
She is a mother of two beautiful girls and is active in her community as a soccer coach and a cheerleading coach through her local parks and recreation department.
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Did you know that Dr. Murray and Dr. Chang have staff privileges at Martha Jefferson Hospital and Augusta Health? They often perform foot and ankle surgery in operating rooms at both locations assisted by extremely well trained, experienced nurses. Today, we are featuring Augusta Health on our blog as they were recently recognized in the top 5% nationally in 2010 for patient safety and overall clinical excellence. Congratulations! We are honored to be part of such a great facility. Here are the details from their website:
Augusta Health was identified as a recipient of the HealthGrades Patient Safety Excellence Award™ today and the only hospital in Virginia to also receive the Distinguished Hospital Award for Clinical Excellence™ this year. These awards indicate that Augusta Health’s patient safety and quality ratings are among the top 5% of U.S. hospitals, in a new study released today by HealthGrades, the leading independent healthcare ratings organization. Augusta Health is one of only 74 hospitals in the country to receive both designations in 2010.Medicare patients at hospitals receiving the HealthGrades Patient Safety Excellence Award™ were, on average, 43% less likely to experience a patient safety event. And, patients admitted to Distinguished Hospitals for Clinical Excellence™ had risk-adjusted mortality rates that were, on average, 29 percent lower than all other hospitals. Risk-adjusted complication rates were, on average, 9 percent lower than all other hospitals. The seventh annual HealthGrades Patient Safety in American Hospitals study and the eight annual HealthGrades Hospital Quality and Clinical Excellence study analyzed nearly 40 million hospitalization records from approximately 5,000 hospitals nationwide that participate in the Medicare program. Participation in the HealthGrades studies is not voluntary, and hospitals cannot choose to opt out of these analyses. If all hospitals performed at the level of Patient Safety Excellence Award™ hospitals like Augusta Health, approximately 218,572 patient safety events and 22,590 Medicare deaths could have been avoided while saving the U.S. approximately $2.1 billion in excess costs from 2006 through 2008. If all hospitals performed at the level of Distinguished Hospitals for Clinical Excellence™, 150,132 patient deaths among Medicare patients may have been prevented and 13,104 in hospital complications among Medicare patients may have been avoided. “We are here to honor our hospital, and our outstanding employees and physicians for receiving national recognition from Health Grades. I am so very proud and personally honored to be associated with such an excellent organization and I speak for all the board members when I say thank you to our employees and physicians for the commitment that they give each and everyday to our hospital and our patients”, says Mary Mannix, F.A.C.H.E. President and Chief Executive Officer. “On behalf of HealthGrades I’d like to congratulate Augusta Health for a track record of patient safety and clinical quality that is among the best in the nation,” said Rick May, MD, a vice president at HealthGrades and co-author of the study. “Hospitals like Augusta Health are setting benchmarks of superior performance that we would like to see other hospitals emulate.”