steroid injections

Corona virus and steroid injections for Morton’s neuroma treatment.

Steroid Injections


Steroid injections are a relatively common treatment for Morton’s neuroma. However, in light of the current Covid-19 crisis we would not recommend anyone having a steroid injection for a Morton’s neuroma, or for that matter, any other musculosketal conditions, such as heel pain or tennis elbow etc. This is because steroid injections, as well as being powerful anti-inflammatory agents are also immunosuppressants, i.e. they reduce the body’s ability to fight off infection. During the flu season prior to giving a steroid injection clinicians screen patients for the presence of chest infections or signs of flu. This is because flu or a chest infection could advance to pneumonia if the immune system is weakened by a steroid injection.


One of the most commonly used steroid injections in the UK for the treatment of Morton’s neuroma is a steroid called methylprednisolone. Methylprednisolone is used elsewhere in medicine to help treat certain types of autoimmune disease. Autoimmune diseases are conditions where the body attacks it's own cells. Examples of autoimmune disease include systemic lupus erythematosus and rheumatoid arthritis. Couples undergoing IVF treatment might also be familiar with methylprednisolone too, as it is often used at the time of embryo implantation, because it helps prevent the mother’s body rejecting the implanted embryo. 

From a lung perspective it is used to treat bronchitis because it dampens down acute inflammation. However, French doctors dealing with Covid-19 have raised concerns about the immunosuppressive effects of steroid injections, as they can in some circumstances cause a delayed healing of lung tissue affected by the Covid-19 virus. There is some speculation that specialist white blood cells called macrophages, which help remove damaged tissue and, are suppressed by steroids. 


For the time being it might be prudent for those with underlying heath problems such as heart or respiratory disease to give steroid injections for Morton’s neuroma a miss. In any event, there is debate about whether or not steroid injections provide any long-term help for neuromas and when they do help, by what mechanism they are providing the relief. The current research suggests that the diameter of the neuroma is quite important. If the diameter of the neuroma exceeds 5.5 mm then the likelihood of gaining any benefit, or the benefit lasting more than a few months is slim. 


Some experts question the ‘anti-inflammatory effect’ of the steroid injection on the neuroma. Some argue that the benefits of the steroid injection are not directly related to the anti-inflammatory effects, but more to the shrinkage of surrounding muscle tissue. Steroid injections are known to cause atrophy or shrinkage of tissue, some think that rather than causing the neuroma to shrink the small lumbrical muscles that surround the neuroma shrink instead, thereby decompressing the neuroma, and giving some tempory relief. However, when the muscles recover to their normal size the neuroma becomes compressed again, generating pain.


The benefits of cryosurgery include:

  • It can be performed without the use of steroid.
  • That the enlarged nerve or neuroma after cryosurgery will return to a normal diameter of 1-2 mm.
  • When the nerve has returned to normal, (typically after 3 months after cryosurgery) there is normally no loss of sensation, and no residual pain.
  • Cryosurgery for Morton's neuroma has an excellent safety record.

If you have recently had a steroid injection should you be worried?

Most definitely not, overall the risk is likely to very small and the data on this issue is still very scant and emerging.  It is worth remembering the worst affected people are people whose immune systems go into ‘overdrive’ and generally methylprednisolone is used for dampening down such reactions. Furthermore, the effects of steroid injections are fairly short lived.

So at the moment we are treating steroid injections as an 'unknown' factor and erring on the side of caution.

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steroid injections

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CRPS

November is CRPS Awareness month

Morton’s Neuroma, CRPS, and the role of Vitamin C and Mirror Therapy.

Complex Regional Pain Syndrome (CRPS, also known as RSD) is a rare, but not uncommon condition that can cause significant, sometimes life changing pain and loss of function in either, the lower leg and foot, or the lower arm and hand. It can also affect those that have had excision surgery for Moron’s neuroma.

CRPS is generally caused by trauma such as ankle or wrist fracture, or by a period of immobilisation such as having the foot or arm in a plaster cast or brace. Sometimes, even a seemingly very minor injury such as a sprained ankle can trigger CRPS.

 


CRPS

Approximately 80% of people affected by CRPS are European, or have European ancestry. CRPS associated with trauma affects approximately 26 people per 100,000 every year (1). Much like Morton’s neuroma it affects 4 times more women than men, and like Morton’s neuroma the typical age of onset is mid-forties. The female bias however, could simply be explained by the fact that women suffer more fractures especially of the wrist than men, making them more likely to develop CRPS.

Most cases of CRPS are associated with fracture and the upper limb seems to be more commonly affected than the lower limb.

CRPS also occurs at a surprisingly high rate of just under 4.5% for those having elective or planned foot and ankle surgery (1), though some UK podiatric surgeons suggest that the risks of CRPS from Morton’s neuroma excision surgery alone is as low as 0.46% (2).

Excision of Morton’s neuroma is the biggest cause of surgically induced CRPS in the foot (3,4). The exact rate of CRPS is hard to know for sure, because estimates are based on retrospective studies that look back on patient’s treatment records, meaning they rely on clinicians being able to recognise and document or report a complex condition that can easily be mistaken for other conditions. The true rate of CRPS could be either higher or lower that the figures quoted (3).

 


What are the features of CRPS?

Constant or fluctuating pain is the most prominent feature of CRPS. The pain is often out of proportion to the injury or stimuli. CRPS can cause a variety of symptoms including, swelling, movement disorders such as tremor or involuntary muscle contraction, and pain is often felt from even the lightest touch or pressure.

Other features include altered skin temperature and altered nail and hair growth, and overall increased sensitivity to pain. Body perception disturbances are not uncommon, such as the hand or foot feeling like it doesn’t belong to the owner.

CRPS is hard to diagnose, for patients developing CRPS following Morton’s neuroma excision surgery, the average length of time from onset to diagnosis is just over 9 and a half months (3). In extreme cases the effects can drive sufferers to seek amputation of the affected limb, however around 16 % of those who proceed with amputation continue to experience the same level of pain.

The outlook for most is good, with many experiencing substantial improvement or remission of symptoms within 12 months, though for some, full recovery may never be attained or can take some years.

Studies have helped develop a profile of those most susceptible to developing CRPS. Just about 50% of CRPS sufferers have a previous history of anxiety and depression. CRPS sufferers are 3.5 times more likely to experience migraine especially migraine with aura than the general population. Smokers and those having repeat forefoot surgery also have increased risk.

The image below illustrates how the foot can look in the early stages of CRPS. The foot is often moderately swollen and slightly discoloured and warmer due to increased blood. In later stages the appearance can reverse, with the foot becoming cooler and darker and slightly bluish-purple discolouration.

 

CRPS

What can be done to reduce the risk of developing CRPS in the first place?

Avoidance of trauma and surgery are the two obvious things that spring to mind. However, as we all know, avoidance of such things, especially slips and trips is easier said than done.

If you are unlucky enough to suffer a fracture or if you are waiting for elective foot and ankle surgery you should give serious consideration to taking Vitamin C.

The reason why is clearly illustrated by a 2007 study of men and women who had fractured their wrists. Following their fractures, 317 patients were given Vitamin C daily for 50 days, and 99 were given a placebo tablet.

Only 2.4% of the Vitamin C group went on to develop CRPS, compared with 10.1% of the control placebo group. This research has since been repeated many times nearly all studies showing Vitamin C can reduce (but not entirely prevent) rates of CRPS in those suffering fracture or undergoing elective surgery (5).

 

 

 


Treatment of CRPS

Like most things in medicine, better outcomes are achieved with early diagnosis and treatment. Treatment typically involves the use of differing drugs that include antidepressants, anticonvulsants and anti-bone loss drugs.

Other treatments includes repeat local anaesthetic injections, epidurals similar to those given during childbirth and spinal cord stimulators.

An emerging treatment that shows some promise that does not involve drugs involves the use of mirrors. The affected side is hidden and the other foot is then observed by the patient performing movement or activities that would normally be painful. Tricking the brain to process information differently does seem to significantly help reduce pain both during and after mirror therapy especially if performed regularly over a 3 month period (6).

 

 


Cryosurgery and CRPS.

Cryosurgery to sensory nerves (the nerves that contain Morton’s neuroma) triggers a localised breakdown of the nerve however the nerve is able to regenerate and return to normal function. Critically, Cryosurgery avoids cutting the nerve. Cryosurgery has been applied to nerves for pain relief since 1961 to approximately 30 nerves throughout the body (7). Thankfully, while CRPS does not seem to be a prominent risk for those having cryosurgery to a nerve or a neuroma, we would still advise anyone having any treatment for a neuroma, be it an injection of steroid, Cryosurgery or excision surgery to consider Vitamin C.

Most studies dealing with Vitamin C and CRPS suggest either taking either a full, or half a gram (1000mg / 500mg) of Vitamin C approximately 1 week before and up to 30-40 days post treatment. Always discuss with your doctor or clinician first.

 

 


Patient Resources

CRPS charity: https://www.burningnightscrps.org

References:

  1. De Mos M, De Bruijn AG, Huygen FJ, Dieleman JP, Stricker BH, Sturkenboom MC. The incidence ofcomplex regional pain syndrome: a population-based study. PAIN 2007;129:12–20.
  2. Tollafield D. Morton’s Neuroma Podiatrist turned patient: My own journey 2018 ISBN-13: 9781981779284 page 95.
  3. Incidence of Complex Regional Pain Syndrome after Foot and Ankle Surgery 2014
  4. Anderson DJ, Fallet LM. Regional pain syndrome of the lower extremity: a retrospective study of 33 patients. J Foot Ankle Surg 38:381–387, 1999.
  5. Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW. Can vitamin c prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. J Bone Joint Surg Am. 2007;89:1424-1431. Mirror therapy for Complex Regional Pain Syndrome (CRPS)-A literature review and an illustrative case report.
  6. Sayegh Scand J Pain.2013 Oct 1;4(4):200-207. doi: 10.1016/j.sjpain.2013.06.002.
  7. Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003; 6(3):345–360

 

 

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Is there a link between Plantar Fasciitis and Morton’s Neuroma?

Plantar Fasciitis


At some point in their life, most people will either suffer from, or know someone who is suffering from a type of heel pain called plantar fasciitis or plantar fasciopathy. The source of the pain is initially caused by inflammation, followed by a prolonged degeneration of the heel bone ligament, called the plantar fascia.

Plantar fasciitis is the most common foot ailment that will prompt patients to see a GP or Podiatrist.

The symptoms include sharp, stabbing pains in the heel and is most noticeable when getting out of bed in the morning or when standing after a period of rest or inactivity. Plantar fasciitis typically grumbles on for at least 6 months, and in some cases many years. Over time, many people with plantar fasciitis gradually alter their walking patterns, taking more weight along the outside of the foot and commonly avoiding placing too much weight directly through the heel itself.


 

Morton's Neuroma


Morton’s neuroma on the other hand is a far less common condition, which causes a burning pain in the ball of the foot and toes. Sufferers experience numbness, pins & needles and sharp, stabbing pains in the forefoot, most commonly between the 3rd and 4th toes, and sometimes between the 2nd and 3rd toes. The cause of the pain is degeneration and thickening of the small nerves that sit between the long bones of the forefoot; the metatarsals. When the thickened nerves reach a certain diameter in thickness they run out of space, leading to the nerve becoming squeezed and irritable. Like plantar fasciitis, Morton’s neuroma sufferers gradually alter how they walk, choosing to slightly rotate the foot outwardly "pushing off" less forcefully through the ball of the foot.


 

 


Very little is known about the rates of cross-over, ie. how many people with plantar fasciitis will go on to develop Morton’s neuroma or vice versa.
However, we do know that there are a number of patients who are unlucky enough to have both conditions simultaneously.


 

What's the link?


A common factor that can predispose a person to both conditions is a reduced ability to point the foot toward the shin bone, a movement known as dorsiflexion. Normal ankle dorsiflexion values range between 0 - 20 degrees. Broadly speaking, the more ankle dorsiflexion you have the better, but as we age, we start to experience reduced ankle dorsiflexion. This reduced ability often stems from tight calf muscles behind the lower leg. Such tightness impinges the ‘up-down’ hinge movement of the foot, causing the foot to adapt and compensate by performing the next best movement which is a ‘rolling in’ or ‘flattening’ movement of the longitudinal and transverse arches of the foot. The rolling in movement (known as eversion) has long been associated with increased rates of Morton’s neuroma and plantar fasciitis.

Studies looking at both Morton’s neuroma and plantar fasciitis have shown reduced ankle dorsiflexion to be a big villain of the piece.

The single factor that chronic plantar fasciitis sufferers share is not age or weight but reduced ankle dorsiflexion. Reduced ankle joint dorsiflexion is found in a staggering 80-85% of heel pain sufferers. It’s a similar picture for Morton’s neuroma; a 2016 study compared 68 patients with Morton’s neuroma to non-neuroma control subjects of similar age, weight, sex and foot type. They found that factors like foot type, foot shape and body weight didn’t really seem to be significant in the formation of neuromas. The big factor that stood out like a sore thumb was reduced ankle dorsiflexion.

They calculated that the odds of developing a Morton’s neuroma increased by a staggering 61% in the right foot and 43% in the left, for every 1 degree loss of ankle dorsiflexion (why there was such a difference between the right and left feet is the subject of another blog entirely).

Treating a combination of conditions


At The Barn Clinic treatment centres in London and Sheffield, we have performed cryosurgery for long term sufferers of both plantar fasciitis and Morton’s neuroma for over 12 years. As such we have built up a vast amount of knowledge about causes and links between the conditions. Accordingly, we now regard reduced ankle dorsiflexion to be at least equal to, the risks of being overweight or wearing poor footwear. In our experience virtually, every patient with either plantar fasciitis or Morton’s neuroma will experience an improvement in their symptoms if they regain a few degrees of ankle dorsiflexion with the appropriate exercises.

So, if you are doubly afflicted with both plantar fasciitis and Morton’s neuroma it is statistically highly likely you will have reduced ankle dorsiflexion, so you definitely should perform calf stretching.  However, Morton’s neuroma pain will only be eased but never disappear with calf stretching alone.  Cryosurgery offers such patients a more permanent solution.  For patients who developed plantar fasciitis after chronic neuroma pain we often find that after cryosurgery for Morton’s neuroma the heel pain will quickly resolve once the person starts walking more normally again.

For those patients who develop Morton’s neuroma pain soon after, or sometimes, a long time after experiencing plantar fasciitis, care must be taken separate out the two conditions from each other. This is because many people have small neuromas in their feet and luckily get no pain from them. Some studies estimate that just over half the population will have a neuroma, however only a tiny percentage of people with a neuroma actually experience pain from them.

Sometimes we see patients that have been diagnosed elsewhere with both plantar fasciitis and Morton’s neuroma based on clinical examination, patient history and sometimes, imaging reports. The difficulty is that sometimes plantar fasciitis can sometime mimic the pain of Morton’s neuroma. This is because the thickened heel ligament can compress the nerves in the heel area that supply the forefoot. When nerves become compressed they radiate pain forwards, and in this case into the ball of the foot. Unless the nerves around the heel ligament are carefully assessed for signs of entrapment a clinician could mistakenly attribute forefoot pain to neuromas (that are actually silent and causing no pain) and not the plantar fasciitis. Accordingly, when we see patients with both plantar fasciitis and small Morton’s neuroma we have found that by treating and curing the plantar fasciitis only with cryosurgery that the forefoot pain previously thought to stemming from Morton’s neuroma disappears when the plantar fasciitis clears up often as early as 3 weeks post cryosurgery.


 

To summarise


If you have both plantar fasciitis and Morton’s neuroma the take home message from this blog is:

  • Ankle dorsiflexion exercises will help (email us for free advice exercise sheet).
  • Plantar fasciitis that developed after a long history of walking awkwardly due Morton’s neuroma can clear following cryosurgery to the Morton’s neuroma only.
  • Plantar fasciitis can sometimes mimic Morton’s neuroma pain. If you have been diagnosed with both conditions simultaneously you need careful assessment.

For more information please visit our sister website


www.plantarfasciitis.co.uk


 

orthotics

Orthotics for Morton’s Neuroma


Do Orthotics help reduce Morton's Neuroma pain?


Our understanding of the answer to this question is based on two things.

  1. The findings of a 1994 Study
  2. Our own day to day clinical experiences of treating 1000s of Morton’s neuroma sufferers with modern orthotics.

1994, as well as being the year the Spice Girls got together and Oasis released their first album ‘Definitely maybe', was the year that the first and more or less only study into the benefit of orthotics for Morton's neuroma was published. It evaluated the effect of using foot orthotics, and particularly their effects on Morton’s neuroma sufferers pain levels.

It showed that depending on foot type, orthotics offered a 45% reduction for pronated (flatter) feet, and 50% reduction for supinated (high arch feet).

The study had a few weaknesses by modern standards. One, being participants had no prior ultrasound imaging to exclude the presence of co-existing problems that sometimes go hand in hand Morton’s neuroma such as arthritis, bursitis, capsulitis etc. Overall, the author did an excellent job with the limited resources available to a UK NHS Podiatry department in 1994. This research has not been significantly updated since 1994.


 


Why hasn't this work been updated?

One of the reasons that this research has not been updated is that it is difficult to find a group of Morton’s Neuroma sufferers who are happy to agree to have no treatment other than orthotics for their neuroma pain for a period of months. This agreement, to have no other treatment, is a requirement of modern study methodology. This is because the scientific validity of a study is undermined if participants use orthotics as well as other treatments, such as physio, stretching icing, anti-inflammatory medications etc. If patients simultaneously use other treatment options, the researchers find it very hard to determine the single effect of using orthotics.

So, to recap, according to the study, orthotics in the distant days of the Spice Girls had a pretty good success rates, a 45% reduction for pronated (flatter) feet, and 50 % reduction for supinated (high arch feet).


 


What about today?

Our understanding of biomechanics and orthotics have moved on a long way since 1994.

These days we are able help a lot more than 50% of patients. The figure in 2019 based on my own experience and based on discussions with colleagues, is a lot closer to the region of between 70-80%.

Approximately 70-80% of patients with established neuromas will see a reduction in their pain levels. It is also our experience that with smaller neuromas, the pain can often totally resolve (whilst the orthotics are being used).


 

What is responsible for the improvement?


There is no doubt that modern orthotic manufacturing, helped by computer aided design and 3D printing, has come on a long way since 1994. Such improvements have allowed Podiatrists to design and prescribe ever more complex devices, which have probably helped raise overall success rates.

However, it’s not just orthotic manufacturing that has evolved. Our understanding of biomechanics has altered significantly since 1994.

When I was a Podiatry undergraduate in the 1990’s a lot of emphasis was placed on ‘kinematics’ or the visual ‘alignment’ or appearance of joints and foot position. Subsequent studies have shown that Kinematics are far less important than we first thought.

In 2019 most podiatrists subscribe more to the tissue stress model, and attempt to alter and manipulate the 3 key variables that are involved in damaged overloaded tissues.

The 3 variables are:

  1. Magnitude of reaction forces.
  2. Vector of reaction forces.
  3. The temporal pattern of reaction forces.

Normally at this point in a blog, I generally attempt to simply and summarise scientific data. But when it comes to the 3 variables above, on this occasion you will simply have either complete a degree in biomechanics or take my word for the fact those 3 variables are not easily broken down into understandable bite sized pieces. Especially how they are applied to orthotics, it is complicated... very complicated!


 

So, is the improvement simply down to better quality orthotics and an improved understanding of biomechanics?


Possibly, but I doubt it is just down to those factors alone.

Our treatment planning involves a very detailed biomechanical assessment that involves ultrasound imaging and elastography imaging of the forefoot. This type of extra imaging data provides a wealth of knowledge.

For instance, a scan will alert us to the presence of co-existing issues that often go hand in hand with Morton’s neuroma, conditions such as arthritis, bursitis capsulitis plantar plate degeneration etc. When we see such issues, we can now alter the design of the orthotic accordingly, making a better outcome for the patient more likely.


 

So, how do orthotics reduce pain?


Orthotics are constructed using corrected 3d models of your own feet. The process of taking the casts of your feet is a highly skilled process that enables your clinician to realign your joints as they take the impressions. When the impressions are poured, orthotists generally make angular corrections to the models of your feet. After this process has been completed, the orthotics are then moulded over the corrected models of your feet.

We know from modern studies that orthotics can reduce abnormal overloading mechanical forces responsible for Morton’s neuroma formation. Some orthotics also have domes that lift and separate the metatarsal bones creating room for the neuroma to sit in.

Orthotics also help reduce the hammering or retraction of the lesser toes. This is very helpful because hammered toes contribute to elevated pressures in the forefoot region.


 

Orthotics - Myth Buster


 

        1. Orthotics act as a brace and orthotics weaken the muscles of the feet.Electromyography (EMG) is a branch of medicine that for evaluates and records the electrical activity produced by skeletal muscles, it can be used to assess the muscles in the feet and legs during walking and running.
          A ground breaking 2009 paper entitled “Effect of foot posture (foot type), foot orthotics and footwear on lower limb muscle activity during walking and running: a systematic review, found the evidence does not support the idea that orthotics act as a foot brace or using orthotics causes muscle weakness. This paper was a quality study that collated the findings of 38 published studies.  It actually found the opposite.  It showed that the muscles of people who had certain foot types that included flat pronated feet only started working normally when the subject used orthotics. There is no evidence that using orthotics is detrimental, quite the opposite.
        2. Orthotics are uncomfortable. Custom made orthotics are orthotics made over models of your own feet. As such the vast majority of our patients find their orthotics comfortable to wear from day one.
        3. Orthotics are expensiveHigh quality carbon fibre orthotics are very durable often lasting many years, and cost as little as £350. Which is approximately £29.17 a month through our 12 Month Interest free Credit Plan.
        4. All orthotics are the same. 

          Orthotics purchased from a pharmacy or a trade fair are in no way comparable to quality prescription devices that are prescribed and fabricated to a prescription unique to your feet.  At The Barn Clinic treatment centres we have over 20 years of experience dispensing Morton’s neuroma.


 

The take home message


  • Custom made and even pre-made orthotics can be very helpful in managing Morton’s neuroma pain
  • Modern manufacturing methods allow for smaller more user-friendly orthotics
  • Ultrasound imaging when combined with a detailed biomechanical assessment can provide better outcomes for patients
  • Orthotics are highly individual and totally dependent of the skill and experience of the clinician providing them

Will my Morton's Neuroma benefit from orthotics?

Well to quote my favourite album of 1994 in the words of Oasis…Definitely Maybe.

They don’t work for everyone but they certainly help the vast majority.


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elastography

Elastography Imaging for Morton’s Neuroma


Elastography imaging of Morton’s neuroma represents possibly one of the greatest breakthroughs in the imaging of Morton’s neuroma in the last 30 years.

It provides a whole new level of detail, a level that until recently, we could have only dreamt of.


Elastography is a specialised form of Ultrasound imaging that can assesses the stiffness of certain tissues. It is commonly used to assess tumours in other areas of the body, such as the liver and breast. This is because tumours are known to be much stiffer than surrounding healthy tissue. A Morton’s neuroma is not cancerous, but like breast and liver tumours, they are known to be a lot stiffer than healthy nerves. The fact they are stiffer means they are perfectly suited to this new form of detection.

Elastography is the ultrasound equivalent of being able to feel a lump between your finger and thumb and instantly know how hard or soft the lump is. Standard black and white ultrasound only gives the user clues as to how hard or soft a tissue is, but no solid facts or data. Elastography Ultrasound on the other hand, utilises a range of measurements and colours that show the user instantly how hard or soft a tissue is. Different colour codes are superimposed over the 2-Dimensional images.

Stiff areas are marked with blue and soft/elastic tissues with various shades red or green.


 

Elastography for Morton's Neuroma


During Elastography imaging, a healthy nerve appears as a shade of green. However, a diseased Morton’s neuroma nerve will change colour and typically show as blue during the scan.

A 2016 study of 24 Morton’s neuroma evaluated the percentage of change in Elastography values between Morton’s neuroma and healthy nerves. The Elastography values of the Morton’s neuromas was 220% greater than healthy nerves in the same or opposite foot. 

Elastography now allows for increased accuracy in the mapping of the Morton’s neuroma. Small, but painful neuromas that could have previously been missed by Ultrasound and MRI can now be detected with Elastography. Elastography also allows us to more accurately assess and treat patients that have had failed alcohol injections, failed neuroma excision surgery and those suffering from a related condition called bursitis.


 

What Elastography means for our Patients


Using elastography will give us an additional level of knowledge and understanding of your condition. This means patients could benefit from a more specific diagnosis, improved insight with regards to recovery and treatment expectations & outcomes, and an even higher level of precision and accuracy in the treatment you receive.

Both conventional Ultrasound and Elastography scanning is provided to all of our patients as standard, and is included in the cost of the assessment consultation.


 

Our Commitment to Investment in new Treatments & Technology


We are proud to announce that as well as being the first to introduce cryosurgery for the treatment of Morton’s neuroma in to the UK over 12 years ago, we are the first and only clinic in the UK offering elastography as standard to all of our patients. We have been so impressed with the extra information that Elastography has provided in our Sheffield clinic we over the last 12 months, that we are pleased to announce we have recently taken delivery of a second brand-new Elastography scanner for our busy London clinic.


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Morton's neuroma

Why does Morton’s Neuroma seem better during the Summer?

Why do so many people report that their Morton's neuroma feels so much better in the summer?


Could it be the sunshine and sangria effect? Where we are either, on holiday or have a holiday to look forward to, or we are super relaxed after a holiday. The sun is shining and psychologically we all feel so much better and our day-to-day problems seem just that little bit less bothersome, including our neuroma. Why should this be, is it all down to the sunshine? Well the sunshine could definitely help.

There is a lot of evidence now, that the sunshine vitamin, vitamin D has an important role to play in the body’s tissue repair and anti-inflammatory mechanisms and we know neuromas do have an inflammatory component to them. Maybe a boost of vitamin D levels, combined with a week or two of the famous Mediterranean diet, high in anti-inflammatory omega 3s, and low in inflammatory omega 6s could be just what the food doctor ordered, however, there is probably something much more simple and down to earth at play.  

For most, once a Morton’s neuroma has reared its ugly head there is a period of time where the symptoms can be managed with lifestyle changes, especially choice of footwear. For most, year by year the symptoms ebb and flow, they feel better in the summer and worse in the winter. This seasonal change is really down to the fact that summer footwear is so much flatter and wider and forgiving.

In a flat shoe, the forefoot region where neuromas form, takes approximately 30% of body weight, this is far more manageable than the 66% of body weight going through the forefoot in a shoe with a higher heel. Secondly sandals benefit from being wider in the toe-box making more room for you and your little foot fiend to get along with each other. 

For the record we don’t sell footwear or have shares in Birkenstocks, and with that said, this year the Birkenstocks Arizona 2019 is a really good choice if you suffer from neuroma, it ticks all the neuroma friendly boxes. It has an adjustable forefoot strap, a supportive cork foot-bed that will support your feet In all the right places. The cork foot-beds also mould around any lumps and bumps your feet might have, meaning the shoe adapts around you and not the other way around (for the friendly people at Birkenstocks reading this I take a size UK 10.5).

October and November are our busiest months, with a large influx of new patients. This is simply because a lot of people can no longer put up with the pain once the neuroma has been compressed again by their winter shoes. Our advice would be, choose your winter footwear very carefully and try and transition into a shoe that is as wide and as flat as possible.

Be kind to your neuroma, don’t go from one footwear extreme to another.


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cryosurgery

8 Reasons to Choose Cryosurgery to Cure your Morton’s Neuroma

 


 

1. Cryosurgery. It Works.

Cryosurgery for Morton's Neuroma has an excellent success rate from just one treatment. 

 


 

2. It’s very safe

Cryosurgery has better success rates and outcomes than neurectomy surgery.  Unlike neurectomy surgery, cryosurgery poses no risk of stump neuroma because there is no cutting of the nerves in the foot.

 


 

3. Minimal Downtime

You can be back to work and driving after a long weekend.

 


 

4. Cost effective.

Most patients spend thousands on shoes and other less effective treatments. Cryosurgery is also the cheaper option in comparison to private neuroma excision surgery.

 


 

5. Time effective.

Many suffers can spend years suffering with Morton's Neuroma. With Cryosurgery, will see their full results in as little as 12 weeks.

 


 

6. Long Term Results.

For most patients, the results are permanent. Our thorough consultation process is also designed to highlight any common risk factors the patient may be exposed to (such as foot-type, hyper mobility etc), and we work with you to put future preventative measures in place.

 


 

7. Single Treatment.

Cryosurgery is carried out in just 1 short treatment. So you don't have to commit to a course of treatments and multiple trips to the clinic.

 


 

8. Affordable for every budget.

We offer 0% Interest free credit, and a variety of finance options to suit your circumstances and your budget.