DEAR DR. ROACH: I am a 68-year-old woman who is in relatively good health. My primary exercise is walking my dogs anywhere from 2-5 miles per day. I have two Morton’s neuromas in my left foot, and I’ve been receiving shots for them for at least the past eight to ten years, with the shots being more frequent in recent times.
Sadly, these shots have diminishing returns and no longer eliminate the pain and discomfort. I wear the appropriate footwear and use metatarsal pads in every left shoe that I own.
I am considering surgery to remove the pinched nerves. Can you discuss the pros and cons of this surgery along with the recovery process? My expectation with surgery is to be able to walk pain-free. (Even if I never wear heels again!) My podiatrist explained that I will have permanent resultant numbness in certain toes post-op. — T.N.
ANSWER: A Morton’s neuroma is a thickening of the nerve in between the toes, usually on one side of the third or fourth toes. You have tried the appropriate conservative therapy with proper footwear and pads to take pressure off the enlarged nerve. Your podiatrist then appropriately tried second-line treatment with injections, but since the injections are no longer working, I agree that consideration of surgery is appropriate.
There are at least two common surgeries for the treatment of a Morton’s neuroma that does not respond to more conservative treatment. The most optimistic studies of these surgeries found a 96% to 97% reduction in pain during daily activities. Other studies have shown less optimistic results, with only 50% of people reporting their results as excellent, 30% reporting good results, and 10% reporting poor or very poor results. About 63% were pain-free during their follow-ups in one large study.
As I have not had a patient undergo this surgery, I can’t tell you my personal experience, but based on the published literature, I would tell you that good results are likely but by no means guaranteed.
The literature also reports that most people can walk after surgery immediately or within a few days, then transition to regular shoes within two to four weeks. Most people do not find the numbness after surgery to be too bothersome.
DEAR DR. ROACH: I’ve been having some eye symptoms, including blurry vision and needing brighter light when reading at night. I have noticed that my night vision is not good, and my distance vision is not as sharp.
I saw an ad for a supplement, which included vitamins A and C, copper and biotin, and lutein and zeaxanthin. Now I’m having second thoughts because it is sounding too good to be true. What do you think of this type of supplement? — R.Y.
ANSWER: This formula sounds similar to (but not exactly the same as) the AREDS2 supplement, which was proven to slow the progression of age-related macular degeneration. To my knowledge, there is no evidence that these supplements, alone or together, are likely to improve your vision symptoms if you don’t have diagnosed macular degeneration.
As always, look for the statement on the label that says: “Statements regarding dietary supplements have not been evaluated by the Food and Drug Adminstration and are not intended to diagnose, treat, cure or prevent any disease or health condition.” To me, the advertising sounds like it is in direct conflict with the disclaimer.
If you are diagnosed with macular degeneration, you need to find out from your ophthalmologist whether a supplement like AREDS2 is right for you. It can be purchased exactly as it was published in the studies. (One brand is PreserVision, but there are others.)
However, your symptoms are concerning, and I don’t think you should just buy a supplement. You should have a comprehensive eye exam if you haven’t had one very recently.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
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