neurapthy/nodules

by susan
(Jackson, New Jersey)

i was diagnosed w/neuropathy in my left foot and it is now in both feet hands and legs. most severe in left foot because i have tumors alongside the arch area(very hard). drs. are hesitant to operate and remove nodules. I haven't been back to the drs. in sev. mos. because i was so frustrated with their outcome. they were afraid that the scar tissue from surgery could be worse. nodules have gotten bigger now and the pain is excrutiating!!! pls. help?

RESPONSE
Hi Susan,
It sounds like you are suffering from plantar fibromatosis. This is a fairly common condition and most foot specialists see it all the time.
There are two issues to discuss here. For years the common thought was that these nodules were harmless and unless they hurt the patient, they could be left alone.
Now the "buzz" in some parts of the medical community is that not all these nodules are always benign and that as a routine measure they all should be examined for potential problems. When I am checking a plantarfibroma, I do it one of two ways. The simplest, outside of the cost factor, is to have an MRI done on the nodules to confirm that they are just that--nodules. The other is to do what is known as a dry tap biopsy, where a needle is injected into the growth and the cells that stick to the needle are put into a solution and then analyzed at a pathology lab. In either even, negative findings will give the patient and the doctor peace of mind.
The second issue is that apparently your nodules are painful so something must be done. Yes, there is an issue with surgery on two fronts. One, the incision is on the bottom of the foot, so there is the risk of scarring, although any surgeon who performs this type of surgery should be aware of that problem and take the necessary precautions. Secondly, there is a high recurrence rate with plantar nodules, yes, they can grow back.
So short of surgery, there are other things you can try. A cortisone injection into the nodule(s) can be helpful in reducing their size and thus the pain. An orthotic (arch support) custom made with cutouts where the nodules are located along with a cushioning material, may also be very helpful.
Both of these treatments are not cures but they have a relative downside. The worst thing that will happen is that they will not work.
Now obviously I have not examined you so I do not know how many and how large the nodules are. The more you have, the more difficult any surgery would become.
If you have already tried the conservative things I have mentioned and they have not worked and you want the nodules removed, and your doctor has explained why he or she thinks it is a bad idea, you can always go elsewhere and get a second opinion. Keep in mind, depending on how bad the nodules are, it might require a skin flap (plastic surgery), along with being off your foot for at least three weeks. These are factors that should go into your decision making process.

Marc Mitnick DPM
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