Responses-Bk neuroma

Responses-Bk neuroma

Steeve Smith

8/3/2007

ORIGINAL POST
Dear List members


I have a below knee amputee, has been using prosthesis for five years.

Patient has volume fluctuations, as well as neuroma. Gets pain on
calf area ( like spasm) , even when he is sitting.

I have tried using harmony system, did help his volumetric problem,
BUT STILL GETS PAIN IN THE CALF AREA ON WALKING AND SOME TIMES IN
SITTING.

There is tender area at lateral distal, under the scar, which on
palpation gives a shooting pain. Patient says that he feels pain in
the absent foot (on palpating that area.

Would highly appreciate your suggestions

Steev
*Responses --*

response: 1
Volume loss over time causes amputated (severed) nerves and neuromas to be
covered by less tissue and become more sensitive to tactile sensation. I had
surgery 2 years post amputation to reduce the neuroma and shorten the
nerve. As I continued to loose volume over the next few years, the neuromas
reappeared close to the skin and sensitive again. I modify my socket to give
a little relief in that area, but not too much as this may create suction or
negative pressure also causing sensation.

Here is my shot in the dark- palpate the nerve path a little further up
(more anterior and proximal) You may find the sensation is also created from
the pressure along the nerve path, specifically the area between the
anterior, distal Tib/Fib. I had to back off on the modification this area.
With normal tissues volumes you modify this area to control rotation, but if
the nerve root is close to the skin it can cause neuroma like sensation.



 2---------

Some people have been successful with the injection of botox into the area.
I have also some study titles on that, if you're interested just let me
know.
The other possibility is to try if electromagnetic shielding can help with
the phantom pain component of the problem. medi USA fabricates a night sock
(Relax Night Care), that you can use as a diagnostic tool to figure out if
it helps. If not, you can return the product and get the money back, because
we guarantee that it works against phantom pain. I'm not sure here, because
there is a neuroma is involved.
If it works though, you can provide a special Liner (Relax Liner) to address
the problem while he's wearing the prosthesis. It all seems to be like the
neuroma does not trigger a local, but a phantom pain. At least for phantom
pain we can provide some solution. The success rate in the treatment with
Relax products is over 80 % (lowering or eliminating phantom pain). I also
have valid study material on that.


 3--------

From personal experience as a BK with 3 removed neuromas, I would
recommend an MRI. The trouble for prosthetists that you seldom can tell
what is under the skin and you can only make a patient so comfortable
when you are battling internal cysts, neuromas and bone spurs. Dammit,
I'm a prosthetist not a magician! (Star Trek fan?)

Let me know if you have any questions. I could forward you a couple of
interesting pics from a revision.


 4----------Provide more info. Like how old is he? Could it be a vascular
problem.
The negative suction or pull? What is his shape? Have you relieved the
area?

5---------

The Ertl revision.
6--------
Check for a boney growth causing the problem