Neuroma Pain of the Foot Successfully Managed with Laser Therapy
Neurological pain in a foot neuroma case is the result of the swelling of the nerve—in this case a non-neoplastic tumor of the foot previously called a Morton’s Neuroma. At one time, the term Morton’s metatarsalgia was used thus avoiding the usage of the term neuroma and association with tumors. Nevertheless, we shall stick to the term neuroma of the foot because this was the diagnosis given by the three medical specialists—a podiatrist, a neurologist and a neurosurgeon—that this patient had seen before coming to our office.
When typical in presentation, a foot neuroma is not difficult to diagnose (see Tables 1 and 2). Early in the course, numbness of the area between the involved toes, usually the third and fourth (see Figure 1), and the middle of the foot occurs. This is followed by constantly changing levels of burning pain to the middle of the foot. Sharp, shooting pain that starts under the metatarsal region begins and then pain often radiates to the two adjacent toes. Pain upon palpation of the inflamed intermetatarsal nerves and the classic metatarsal “click” on manipulation of the involved digits were found.1 Satisfied that this was a case of a benign neuroma, further diagnostic imaging techniques were not repeated as they were already available from the previous examining doctors.
In a certain percentage of the population, the neuroma pain seems to get better then returns with a vengeance for no apparent reason. The involved area may develop severe prolonged burning pain with occasional “fire-like” stabs of pain. This protracted pain is what brought the patient into our office. The significance of this condition lies in the fact that it is one of the most common conditions that drive people to a pain management specialist.1,2 This is especially true of the active lifestyle person. They may be athletes or former athletes that want to continue their exercise routine or their selected activity but the pain has become unbearable.
Mrs. MB, a 48-year-old Caucasian, former athlete, not overweight, and in good general health, was at the end of her rope. She had tried everything the medical profession had suggested: corticosteroid injections, alcohol injections, and several prescriptions from each doctor. She decided not to resort to the surgery the neurosurgeon had suggested. She still had numbness and a burning pain that she could no longer endure after three years of going from specialist to specialist. She thus decided to try an alternative approach she had read about that offered good relief…acupuncture therapy. Her primary doctor agreed.
The primary lesion was on the right foot with a similar pain beginning on the left foot in the same area. The pain had begun to cause her to have an abnormal gait and, in turn, had caused her low back to begin to bother her. She wanted to take care of the foot pain and then, hopefully, everything else would disappear.
At the time she was first seen in our clinic, the pain was constant and extremely severe, which she described as a 10 on a 1 to 10 point scale of pain intensity. The patient could not be touched in the area and had to wear a very light shoe covering. She could not sleep well and had to be heavily medicated for pain reduction. No formal assessment of the patient’s chronic pain had been made since under medical care.
Upon examination, the patient’s posture was mildly kypothic and away from the painful right foot. She had a continuous aching and burning of the distal foot associated with hyperpathia and dysesthesia. This was increased with light palpation of the area. There was a feeling of fullness and edema of the distal foot and toes and episodic pains shooting out in a 13 mm circumference around the inflamed area. There was a definite daily pattern of increased pain during weight- bearing activity.
Examination of the integument revealed rubor, parlor, and dolor of the third and fourth toes of the right foot. Movement of the trunk did not increase pain unless the foot was planted on the floor. When she stood on her foot, or walked more than two or three steps, the pain increased and there was rigidness transferred to the spinal musculature all the way to the neck. Neurological examination of the cranial nerves and extremities were unremarkable with the exception of the feet. Ophthalmic involvement was not noted on examination. Acupuncture examination of the tongue and pulse revealed the following.
- Pulse: wiry, slow, thin
- Tongue: pale, thin, red
Methods and Materials
Treatment consisted of a brief introduction of acupuncture theory and principles to reduce her pain. We usually begin treatment with acupuncture for three to five treatments and then switch to laser therapy once the pain has started to reduce. However, this patient threw us a curve ball: she could not tolerate the idea of needle acupuncture nor was she willing to try. We had previously wanted to use laser therapy for an entire case of neuroma pain and this was an opportunity. We discussed the options with the patient and she agreed.3
Patient informed consent was obtained before the start of the investigation. The patient was not under any social or psychological treatment. Bilateral acupuncture points were selected based upon the author’s 35 years of acupuncture knowledge and experience (see Table 3). The points selected were used throughout treatment.
The Medical Laser Systems Corporation was contacted in Branford, Connecticut to ask for permission to use the laser system in the case study. Permission was obtained and treatment outlined for the case with the patient.
The Luminex 500 impulse time was 35 per point for two rounds. Treatments were given two times per week for four weeks, reduced to one treatment per week for three weeks and one treatment for the month following the last two-week session, for a total of twelve treatment sessions (see Figure 2). Before each treatment session, the patient was asked to rate her pain according to a 10-point scale (see Table 4) adapted from the McGill Pain Questionnaire.4