neuroma information stacy witfill

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What is a Neuroma?

A neuroma is a painful condition, also referred to as a “pinched nerve” or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth toes. It brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.

The principal symptom associated with a neuroma is pain between the toes while walking. Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe. The vast majority of people who develop neuromas are women.

Causes

Although the exact cause for this condition is unclear, a number of factors can contribute to the formation of a neuroma:

  • Biomechanical deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition.
  • Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve.
  • Improper footwear that causes the toes to be squeezed together is problematic. Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.
  • Repeated stress, common to many occupations, can create or aggravate a neuroma.
  • Hallux limitus at the level of the 1st MPJ joint is often associated with a neuroma involving the 2nd
  • High intensity sports such as surfing, running, hiking can predispose a patient to developing a neuroma.

Symptoms

The symptoms of a neuroma include the following:

  • Pain in the forefoot and between the toes
  • Tingling and numbness in the ball of the foot
  • Swelling between the toes
  • Pain in the ball of the foot when weight is placed on it

Home Treatment

What can you do for relief?

  • Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.
  • Wear shoes with thick, shock-absorbent soles, as well as proper insoles that are designed to keep excessive pressure off of the foot.
  • High-heeled shoes over two inches tall should be avoided whenever possible because they place undue strain on the forefoot.
  • Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort.
  • Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.

When to Visit a Podiatrist

Podiatric medical care should be sought at the first sign of pain or discomfort. If left untreated, neuromas tend to get worse.

 

 

Diagnosis and Treatment

Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical correction.

For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, additional treatment or surgery may be necessary to remove the tumor.

The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops. Your podiatric physician will examine and likely X-ray the affected area and suggest a treatment plan that best suits your individual case.

Padding and Taping: Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma.

Medication: Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the neuroma.

Orthotics: Custom shoe inserts made by your podiatrist may be useful in controlling foot function. Orthotics may reduce symptoms and prevent the worsening of the condition.

Surgical Options: When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Your podiatric physician will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.

A endoscopic decompression  surgery can be done is some cases.

 

Prevention

Although the exact causes of neuromas are not completely known, the following preventive steps may help:

  • Make sure your exercise shoes have enough room in the front part of the shoe and that your toes are not excessively compressed.
  • Wear shoes with adequate padding in the ball of the foot.
  • Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).

 

Stacy Witfill

Board certified foot surgeon

18 years private practice

Dunnellon Podiatry Center

 

 

Chemical Matrixectomy by Stacy Witfill DPM

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Onychocryptosis or more commonly referred to or known as ingrown nails can be painful and dangerous for high risk diabetic patients and patients with peripheral vascular disease. The condition can be painful for any patient and often “even the bed sheets cause the toe to hurt” The following article outlines a permanent procedure for removing ingrown toenails. Diabetic patient should first be assessed for peripheral vascular disease and glycemic control before performing the procedure. Consideration should be made to the kidney function of patients as 5-10 percent of these patients will develop post-operative infections and require systemic antibiotics. These considerations should be discussed with the patient during the pre-operative visit.

In addition care should be taken to fully evaluate the patient for any associated benign or malignant tumors involving the nail before performing a chemical matrixectomy. Although rare, any unusual “proud flesh” or unusual pigmentation of the nail bed should be biopsied before performing a chemical matrixectomy. Such benign tumors include warts(periungual and subungual), fibroma, neurofibroma, pigmented nevus, pyogenic granuloma(periungual and subungual), glomus tumor,myxoid cyst, acquired digital fibrokeratoma,keratoacanthoma, bone cysts including subungual exostosis,osteochondroma,enchondroma. Malignant tumors include bowens disease,metastatic carcinoma most commonly associated with a club appearing nail, basal cell carcinoma,malignant melanoma, and squamous cell carcinoma(the most common malignant cancer see associated with ingrown nails. If there is any clinical suspicious findings which could indicate any of the above conditions the patient should be advised of this and appropriate biopsy carried out.

There are also associated biomechanical etiologies of ingrown toenails that can be considered before performing a chemical matrixectomy. For example hallux abducto valgus deformity that is severe enough to cause the lateral border of the nail to impinge against the medial border of the 2nd toe causing the nail fold to overgrow the nail plate and thus causing the nail margin to embed within the tissue. In this situation the patient should be at least advised on the underlying etiology and at least given the option to trying a simple pad between the toes as an alternative to a chemical matrixectomy.

Performing a chemical matrixectomy

Infiltrate 3 cc of lidocaine 2% in standard hallux block. Standard prep with iodine. Introduce a freer elevator under the hyponychium and the eponychium Using a longitudinal nail splitter, create a vertical incision into the nail plate the level of the proximal nail plate. Utilize a 61 blade to finish the cut under the eponychium. Remove the offending nail border with a straight hemostat. Apply 89% phenol for 30 seconds. Repeat 2 applications of phenol. Rinse copiously with alcohol. Utilize a currette and remove excess tissue. Apply silvadene with a dry sterile compressive dressing. Follow patient as needed every 1-2 weeks.

 

Chemical Matrixectomy by Stacy Witfill DPM

Tags

,

Onychocryptosis or more commonly referred to or known as ingrown nails can be painful and dangerous for high risk diabetic patients and patients with peripheral vascular disease. The condition can be painful for any patient and often “even the bed sheets cause the toe to hurt” The following article outlines a permanent procedure for removing ingrown toenails. Diabetic patient should first be assessed for peripheral vascular disease and glycemic control before performing the procedure. Consideration should be made to the kidney function of patients as 5-10 percent of these patients will develop post-operative infections and require systemic antibiotics. These considerations should be discussed with the patient during the pre-operative visit.

In addition care should be taken to fully evaluate the patient for any associated benign or malignant tumors involving the nail before performing a chemical matrixectomy. Although rare, any unusual “proud flesh” or unusual pigmentation of the nail bed should be biopsied before performing a chemical matrixectomy. Such benign tumors include warts(periungual and subungual), fibroma, neurofibroma, pigmented nevus, pyogenic granuloma(periungual and subungual), glomus tumor,myxoid cyst, acquired digital fibrokeratoma,keratoacanthoma, bone cysts including subungual exostosis,osteochondroma,enchondroma. Malignant tumors include bowens disease,metastatic carcinoma most commonly associated with a club appearing nail, basal cell carcinoma,malignant melanoma, and squamous cell carcinoma(the most common malignant cancer see associated with ingrown nails. If there is any clinical suspicious findings which could indicate any of the above conditions the patient should be advised of this and appropriate biopsy carried out.

There are also associated biomechanical etiologies of ingrown toenails that can be considered before performing a chemical matrixectomy. For example hallux abducto valgus deformity that is severe enough to cause the lateral border of the nail to impinge against the medial border of the 2nd toe causing the nail fold to overgrow the nail plate and thus causing the nail margin to embed within the tissue. In this situation the patient should be at least advised on the underlying etiology and at least given the option to trying a simple pad between the toes as an alternative to a chemical matrixectomy.

Performing a chemical matrixectomy

Infiltrate 3 cc of lidocaine 2% in standard hallux block. Standard prep with iodine. Introduce a freer elevator under the hyponychium and the eponychium Using a longitudinal nail splitter, create a vertical incision into the nail plate the level of the proximal nail plate. Utilize a 61 blade to finish the cut under the eponychium. Remove the offending nail border with a straight hemostat. Apply 89% phenol for 30 seconds. Repeat 2 applications of phenol. Rinse copiously with alcohol. Utilize a currette and remove excess tissue. Apply silvadene with a dry sterile compressive dressing. Follow patient as needed every 1-2 weeks.

 

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Winter Sunrise by Stacy Witfill

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Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill

Stacy Witfill

Winter Sunrise by
Stacy Witfill