What Are Stump Neuroma?
Stump Neuroma are scar tissues caused by Morton’s Neuroma excision surgery or trauma.
What Causes A Stump Neuroma To Form?
Transection or ‘cutting’ of peripheral nerves (found in the hand and feet) often results in the formation of scar tissue at the point the nerve was cut. Over time the nerve end develops into a bulbous painful ‘stump’.
Histologically, the bulbous area contains increasing amounts of connective tissue. After the initial operation, fibrous connective tissue proliferates, causing continuous irritation of the healthy nerve and finally a large mass of nerve and connective scar tissue.
This fibrotic scar tissue or ‘stump’ ultimately compresses the healthy tissue of the surviving nerve, causing pain that is often equal to if not greater than the original neuroma pain.
Other Causes Of Stump Neuroma Apart From Surgery Or Trauma
A course of alcohol injections can cause a mass of scar tissue similar to a stump neuroma. Such patients can also be treated successfully with cryosurgery.
How Common Are Stump Neuroma?
Researchers have reported that up to 30% of neuroma operations for hands result in the development of painful stump neuroma. Stump neuroma or neuromata (plural) resulting from foot surgery for Morton’s Neuroma are poorly understood.
Over the years that Morton’s Neuroma excision surgery has been performed it has not been fashionable to assess or discuss the rates of stump neuroma formation. Indeed, little is known about how common stump neuroma occur after surgery – however, it is estimated rates vary between 30-40%.
In the past, sufferers of Stump Neuroma had few options:
Option 1 – Simply to live with the pain.
Option 2 – Repeating the initial operation.
This involves cutting the nerve further back. However, we know that people who have developed a stump neuroma once frequently develop additional stump neuroma after repeat surgery.
Research also shows that the more times a nerve is cut, the greater the chances are of developing a rare but debilitating condition called Complex Regional Pain Syndrome (CRPS). CRPS is associated with direct trauma to a nerve.
Option 3 – Experimental surgical techniques, such as capping the nerve endings in silicone or burying the nerve stumps in bone or muscle.
These methods have often been attempted with varying levels of success as techniques designed to reduce the chances of stump neuroma reformation.
Option 4 – Drug Therapy
Certain types of anti-depressant drugs such as Amitriptyline, Nortriptyline, Duloxetine and Iofepramine and anti-epileptic drugs called Carbamazepine and Gabapentin have been shown to be helpful.
They can reduce the excitability and pain levels of the stump neuroma. Such drugs are often prescribed by NHS pain management clinics and have the risk of side effects. Usually, they reduce pain levels but don’t always totally eradicate the pain – but they can definitely make the pain more manageable on a day-to-day basis.
Now An Effective Alternative Treatment - Cryosurgery – shrinkage of scar tissue through freezing
Since Mr. Weaver introduced cryosurgery into the UK for the treatment of Morton’s neuroma and plantar fasciitis he has now successfully performed in the region of 1000 Morton’s Neuroma treatments. During this time he has developed a separate treatment protocol for stump neuroma sufferers.
He devised this new technique to deal with the increased amounts of scar tissue associated with the stump neuroma. He has since been able to help many patients with their stump neuroma.
Does Cryosurgery Work For Everyone With Stump Neuroma?
Every case is unique, and sometimes the scar tissue in the stump does not shrink sufficiently to provide total relief, however it is rare for such patients to obtain no relief at all. In such cases, repeat treatment can be performed, but it is important to remember that the condition can still improve up to 12 months post cryosurgery treatment.
Main Advantages Of Cryosurgery Over Repeat Conventional Surgery;
- Cryosurgery avoids further cutting of the nerve and is not likely to cause more permanent damage to the healthy nerve.
- In addition to freezing and shrinking the scar tissue (which causes the pain) cryosurgery will also reduce the excitability and conductivity of the healthy nerve. This process is known as cryoanalgesia and is temporary. The ‘cryoanalgesia effect’ helps in the recovery phase, meaning patients typically have little to no pain in the recovery phase.
- Patients can return to work within a matter of days. No crutches or casts are required.
- Complications from treatment are rare.
How Long Does The Cryosurgery Treatment Take?
Typically, patients attend for an hour assessment appointment. During this appointment a detailed medical history is taken, followed by a physical examination and an ultrasound scan of the foot.
If your symptoms are made worse by a certain pair of shoes you should bring them with you for your assessment – you should bring them but NOT wear them. If you are a suitable candidate for treatment you will be given a detailed explanation of what the treatment involves, although this information is contained in an information document that you will have already received prior to your appointment. Should you decide to proceed, we will then offer you an hour appointment for your cryosurgery (or one and a half hours for two stump neuroma).
The appointment for the treatment itself is generally on a separate day. However, if you are travelling a long way to attend we can arrange a morning assessment appointment, followed by an afternoon treatment appointment. Please note that if an afternoon treatment appointment is made for you in advance it is not a guarantee that treatment will take place. This is because the treatment is subject to an assessment and on rare occasions we find that some patient’s pain is not stemming from the forefoot, but somewhere else such as a pinched nerve in the ankle or back (see other forefoot pain page). In such cases cryosurgery would not be appropriate.
Our expertise is unrivalled. Podiatric cryosurgery is an advanced and highly skilled technique that requires a wide breadth and depth of knowledge and skill to obtain good patient outcomes. At The Barn Clinic, we have the expertise to help you.
Mr. Robin Weaver at The Barn Clinic in Sheffield was the first clinician in Europe to use cryosurgery for the treatment of Morton’s Neuroma, plantar fasciitis, plantar fibroma and osteoarthritis of the ankle joint.
We are now the first clinic worldwide to successfully treat stump neuroma with cryosurgery. We are now frequently asked to provide cryosurgery training and advice and share protocols with other Podiatrists, Doctors and clinics.
Take The First Steps Towards Recovery
If you want to enjoy the things in your life that you thought were no longer possible due to your stump neuroma, call our clinic and speak to Georgia on 0114 221 4780. Georgia will be your point of contact and will send you an information pack, deal with your appointment requirements, and generally ensure your treatment is a smooth and enjoyable process.