Use surgery as last resort for foot pain

DEAR DR. GOTT: Could you please address the causes and cures for Morton’s neuroma of the foot? Is surgery the ultimate answer? If so, how effective and safe is it?

DEAR READER: A Morton’s neuroma is a noncancerous growth of thickened nerve tissue that can present in several areas of the body. It commonly appears in a nerve of the foot between the third and fourth toes, causing burning pain, numbness and tingling in the ball of the foot. The condition may occur because of injury, irritation, jogging, bunions, hammertoe, pressure such as from tight or poorly fitting shoes, or for numerous other unknown reasons. The difficulty is that there are no outward signs – no growth, bump or lesion.

Once diagnosed, the first step is to attempt to eliminate the offending cause, such as changing shoes, using arch supports and refraining from jogging or other physical activity temporarily. In the case of a hammertoe or bunion, surgical intervention might be necessary.

Treatment by a primary-care physician or surgeon depends on the severity of the condition. Mild cases might be handled by over-the-counter aspirin or ibuprofen, ice, massage and resting the foot. More severe cases might require steroid injections to reduce the inflammation, diluted alcohol injections and, last but not least, surgery when all else has failed. The downside to surgery is that both the neuroma and nerve are removed, sometimes resulting in permanently numb toes.

My recommendation is to try all the recommendations herein and consider surgery as a last resort.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a check or money order for $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR DR. GOTT: Will you write about bipolar? What is it, and why do some people get it? Is there medication that helps?

DEAR READER: Bipolar disorder, also known as manic-depressive illness, is a disorder that results in mental instability characterized by extreme mood swings and fluctuations in energy and activity levels, and the ability to carry out daily tasks. The cause is not known. Possibilities include hormonal changes, family history and environmental stress.

A physician should be consulted by anyone who experiences symptoms of aggressive behavior, hopelessness, sadness, fatigue, suicidal thoughts, irritability, agitation and severe fluctuations in mood that affect normal activity. Testing will likely include a complete examination, lab testing and a psychological evaluation. Medication is vital for treatment, as the condition will not improve on its own.