Morton's Neuroma & cortisone/alcohol injections

[bns]

Hello,

I appreciate your time in answering questions. I've taken some time to look through the forum and would like to ask a couple of questions. I'm a 40yo male, 6'0" and 165lbs.

Background - I started running about 2 years ago and average 20-30 miles/week, running 4-5 days per week. I've run a few half marathons and shorter races and look to continue my training to my first marathon next year. After about a year of running, I was getting pain in the ball of my foot. When the pain got to the point that it forced me to walk during a half marathon (about the 10mi mark), I saw a podiatrist. She confirmed Morton's Neuromas and gave me a series (3 x over 6 weeks or so) of cortisone shots between the 2nd and 3rd and 3rd and 4th toes of both feet. She also ordered some orthotics with the metatarsal pads. The shots did wonders and within a couple of days I was running again with just some soreness/bruising at the injection sites which slowly went away.

The orthotics helped and I would wear them in all my shoes - dress and running. I had a couple of "relapses" and have been back to get cortisone injections every 2 months or so for one foot or the other. This last time, I went in with pain under the first toe on my right foot. My fat pads are very thin and the orthotics under my big toe joints were wearing more than the rest of the orthotics. We're ordering new orthotics with a more durable top cover and some other minor adjustments. This, I believe, should help. At this same time, I was having neuroma pain in my left foot, so she gave me the cortisone injections again.

My concern is that the pain is worse now in my neuroma than it was before the injections. I'm not sure if she missed the neuromas or not, but it might be a possibility? The bruising was much worse this time, and the injection sites are both clearly visible even 10+ days later. They're not small pin-hole looking, but are much larger than I think they should be. I haven't been able to run since the appointment, and walking barefoot is almost out of the question. I walk 1.5mi from where I park to work and back every day. When walking across a street, if I have to jog across, the pain radiates up my middle toe and is very painful under that toe. There's also some numbness feeling there too. Walking isn't too bad if wearing orthotics/shoes, but running puts too much pressure on that area and is very painful.

Besides going nuts not being able to run, I am concerned whether this sounds like it's only the neuroma and that maybe another round of injections will clear it up, or if there's a possibility there's something else there. The neuroma pain has primarily been in the ball of the foot and hasn't radiated out to the toes until after the injections.

Is there a possibility that the injections did more damage or missed the neuroma and that's why it's not improving? Could there be something else wrong? I go in on Monday for my new orthotics "casts" and it will be another couple of weeks before I get the new ones. I also have an appointment with the podiatrist later that day (she doesn't do the casts) to discuss the pain that hasn't gone away. When the neuromas have come back, I've been quick to get in and get the injections so they don't get out of hand before I go back. Usually, just one round gets them back under control, so I'm wondering why one round didn't take care of it this time or why it would have gotten worse. Just looking for some thoughts/input on what you think so I can go in educated.

One final question is since my neuromas continue to return, is the next step the alcohol injections to "kill" the nerves? I'd prefer not to have the surgery to cut them since I've heard it's not always successful and that they may come back. Killing them seems like the best next step, then surgery.

Thank you for your time!

[FootDoc]

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Local corticosteroid injections may be useful in the palliative, temporary treatment of neuroma symptoms, but they have no ability to cure the problem and symptoms most always return. If they do not, it is not because of the injection. Relief lasts for variable amounts of time and some patients opt for repeated injections if the intervals between symptoms are lengthy. But eventually, most neuroma patients come to the realization that if they wish to permanently rid themselves of the symptoms, some sort of invasive procedure to kill, reposition or remove the neuroma will be necessary. The problem with corticosteriod injections when they work for a time is that the patient most always thinks that the next series of injections will cure the problem and that is just about never the case, as the most the injections can due is to temporarily relieve some of the pressure on the neuroma. Personally, I prefer excision of the neuroma, but you will get other opinions from other podiatrists.

[bns]

Thank you, Doc! The radiating pain is symptomatic of Morton's, correct? This is the first time I've had the radiating pain in addition to the pain in the ball of the foot. I know the alcohol injections aren't 100% successful, but is that a reasonable first shot (haha) at long term relief, followed with excision if unsuccessful? My primary reason in asking is that the recovery from the injections is a day or so vs. 4-6 weeks for each foot. I don't doubt that there's a real possibility I'll need to have the surgery, I'd just like to avoid it if possible.

Thanks!!