Neuroma pain can be debilitating
It is tough to decide what to do when you have a medical health problem that you yourself specialise in. Sometimes common sense goes out the window especially when one regards advice to patients as sensible and practical. Of course patients should listen to your very word. So, how was it I failed at every point to deal with my Morton’s neuroma? This is where a particular nerve branch in the foot is trapped between two bones – metatarsals, then thickens. The effect creates abnormal nerve messages. For podiatrists and Podologues, orthotists, orthopaedic surgeons, physiotherapists this would be well known and of course interests a number of groups of health care workers.
Orthoses were my fall back and they certainly helped more than I imagined. One day I was cycling and I could not believe the pain I was experiencing. Something inside snaps and you realise you are now the patient and need to do something.
I deal with heaps of metatarsalgia in practice and now have chalked up forty years, with thirty as a podiatric foot surgeon. If anyone should know what to do it would be me. I arranged a steroid injection and was shocked to see this last 48 hours – if that! I headed up to my radiologist and had an ultrasound. Seriously I was now some five years on with this problem which initially was mild. This was daft, why had I not done something before?
‘Yep, there is is,’ Dr X-ray said.
‘Looks like a bursa, but then it could be a neuroma.’
I knew it was not synovitis and indeed the ultrasound confirmed the joint was unaffected. Ultrasound is the first port of call for a diagnosis and in my clinic used before an injection. The learning curve started again…
“you are never too old to learn and learning should never stop”
An appointment through my GP saw a referral to a good colleague (Mr Footman) 180 miles north of where I lived. Pre-admission checks followed and surgery was scheduled just before Christmas so I could complete my own work load commitment. I came around from the anaesthetic and Mr Footman appeared, plastic container in hand. A white piece of tissue bounced up and down like a shake up ‘snow globe’.
‘Pretty large Dave, one of the largest I have seen!’ he said.
Post-operative blurry eyes could barely make it out as I reclined sleepily back on the bed. So that was it. My neuroma was gone. My experience in the post-operative recovery period had just started and this was one encounter with medicine and surgery that was unpredictable. I broke many rules but made many discoveries. It was then that I decided to write a book – my journey.
‘Prepare to Limp’, was the title. That soon went by the wayside and talking to a good colleague we hit on the title Morton’s Neuroma. Podiatrist Turned Patient: My Own Journey.
The range of material available to the public was poor on this condition, most, dry as dust. Surely I could bring this alive somehow? The patient experience or journey needed to be broken down into manageable, bite-size chunks; facts brought together in one place. All specialists, and by that I mean people who offer surgery, will provide information in the form of factsheets. Some are wonderfully presented and, when concise, helpful – but many are woefully brief or too simplistic and omit often needed detail. I believe patients understand more than we give them credit for, and many facts are obscured by medical jargon. Phrases such as ‘informed choice’ are considered modern, but deeper down being informed can only happen when everything is fully comprehended.
My decision to emphasise the ‘impact’ of treatment for Morton’s neuroma is related to a greater demand placed on the treating clinician to clarify aspects of treatment, once taken for granted. Healthcare professionals do not intentionally hide facts, but the downsides of care have to be balanced with the benefits.
I sat down and rattled off the first draft in May 2017, having carefully kept a daily log, now at five months. I deliberately held off trying to write before.
Writing is not a quick pastime if you want to do it well. My last efforts took four years to write 2 textbooks. At the time the internet was not exactly accessible in the way it is today. The 25,000-word marker came up and I stuck there with six chapters. By the time my copy editor came on board and colleagues had an opportunity to hack at it, seven chapters emerged.
Today, as I write this piece for LinkedIn I am pleased to see my book lodged on the wonderful world wide platform – AMAZON – 25th November 2017.
Two learning curves emerged; information for patients by a real patient and foot specialist and secondly, a how to do an e-book publication. A new world appears before me with exciting opportunities. There it was, my book with a professional cover and the customary blurb. I hope it helps patients. For me this was a cathartic experience.