Neuroma treatment -- PRP?

I've had a decompression procedure on a Morton's neuroma that is not progressing/recovering very well.  Went great many years ago with the other foot, but this one not so much.  Had to cancel a big bike tour and haven't climbed in over six weeks.  Ugh.

Anyway, doc says next step is PRP therapy, the one where they take your own blood, spin it to separate out the platelets and other goodies, then inject that back into the problem area.

Anyone had this done?  Your experience?  Thanks one and all for anything you can throw my way, even snark!  If it's the good stuff.  If PRP doesn't work, it's another surgery that will involve snipping the nerve.  Want to avoid that if possible, but not biking and climbing hard isn't cutting it.  Grrrr.

I get it, I had to stop climbing for what I expected to be about two months due to a neck injury but it’s turned into a year and a half (so far). I started mountain biking and lately that has been shelved because it seems to trigger large inflammation responses that for me are best described as flare ups. I love the idea of PRP, I think it could be a very useful tool for healing injuries in a low blood flow area. I’m not sure how useful it would be though if I don’t also address all the issues that put me there in the first place. Most articles online say that my nerves should adjust within 6-8 weeks, but the people that have been through it say they didn’t feel like they were really past it until 3-5 years… So it turned out I was headed for a master class in how to be healthy for the long term.

There’s a good track record with PRP, but after two surgeries and the threat of a 3rd, what are you hoping it will do?

Thanks for the reply, Austin. One surgery was the right foot

I saw that, but it’s the same type of injury, yes? I’m just saying that it sounds like a trend, and there might be more to address before PRP can truly do it’s job. For me, my brain insisted that I must always push through the pain. No amount of medical intervention would be able to save me from myself lol.

This is open access.

Urits et al., (2020). Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive Review.  Pain Therapy,9(1),145-160.

Hey, Austin.  Yeah, same thing.  Pretty common amongst we climber folk, especially as we get older.  Turns out four decades of jamming your feet into tight shoes can have negative consequences!  Who knew?  Seeing a body worker.

@WF:  Thanks!  Of the studies listed, the most applicable one--re. fascitis--had a positive outcome.  Achilles tendonitis, not so much.  Looks like it may be worth a shot if the body worker program doesn't help.  I've met my deductible limit, I think, so going for it shouldn't hurt too much $$$.  Physical pain?  Hah.  Wife says:  It's only pain.  How much longer do you expect to live, anyway?

BAd wrote:

Hey, Austin.  Yeah, same thing.  Pretty common amongst we climber folk, especially as we get older.  Turns out four decades of jamming your feet into tight shoes can have negative consequences!  Who knew?  Seeing a body worker.

@WF:  Thanks!  Of the studies listed, the most applicable one--re. fascitis--had a positive outcome.  Achilles tendonitis, not so much.  Looks like it may be worth a shot if the body worker program doesn't help.  I've met my deductible limit, I think, so going for it shouldn't hurt too much $$$.  Physical pain?  Hah.  Wife says:  It's only pain.  How much longer do you expect to live, anyway?

Ha, this changes my approach a bit. I’m 33 and was picturing you to be around my age, your original post reminding me so much of myself. With that info I’d say screw it man, shoot it up. What do you have to lose? Lol

If you can access these, they might be helpful. Reasonably current.

Matthews BG, Hurn SE, Harding MP, et al. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta-analysis. J Foot Ankle Res 2019; 12:12.

Thomson L, Aujla RS, Divall P, Bhatia M. Non-surgical treatments for Morton's neuroma: A systematic review. Foot Ankle Surg 2020; 26:736.

Thanks, I'll check them out.

Have you addressed non-climbing footwear, or tried a product like Correct Toes? Neuromas form when the metatarsals are squeezed on the nerve, so wearing wider shoes (Altras, for instance) with Correct Toes has proven to work for a lot of people. You probably can't undo the damage, but if you recover and want to prevent it from happening again, I'd look into a holistic approach. I work for two doctors who treat neuromas, bunions, etc., with wider, flatter shoes and Correct Toes. Metatarsal Pads can also help spread the transverse arch that runs along the ball of the foot.

I'm always amazed to see climbers on casual outings wearing their approach shoes. If you're going to squeeze your toes into climbing shoes for hours at a time, at least give them a break when you're not climbing. Cycling shoes are pretty bad for feet, too, but that's another topic.

NaturalFootgear.com has a lot of info on holistic approaches, exercises, and overall prevention. Best of luck! Neuromas suck.

Thanks, A Potter.  Yeah, I'm on those options.  I'm using Hokas, those toe things, etc.  Going to a body worker tomorrow.  Hearing good stuff about PRP, so I will probably try it.  I'll post updates so others might benefit.

Quick update.  I had the PRP injection--muy painful, way more than the surgery.  Limped around pretty good for at least a week.  Now, four weeks out, I DO seem to see some improvement.  I've been hiking up to 5 miles or so on sometimes uneven terrain.  I've started climbing again, but it's not the foot it used to be.  On another climber's advice, I've taken to using a metatarsal pad stuck to the arch area of the foot and pasted another smaller pad right over the ball where the main affected area is located.  I've climbed up to easy 10 without too much pain, so I'm back in the game.  I just hope to see continued improvement.   Frustrating, but at least I'm getting after it somewhat.  Haven't tried a really hard bike ride yet.  Waiting for things to cool off.  On the road for a a climb/bike/hike trip in Sept.  We'll see how she flies.  Cheer, beers, and check yer knots.

A Potter wrote:

Have you addressed non-climbing footwear, or tried a product like Correct Toes? Neuromas form when the metatarsals are squeezed on the nerve, so wearing wider shoes (Altras, for instance) with Correct Toes has proven to work for a lot of people. You probably can't undo the damage, but if you recover and want to prevent it from happening again, I'd look into a holistic approach. I work for two doctors who treat neuromas, bunions, etc., with wider, flatter shoes and Correct Toes. Metatarsal Pads can also help spread the transverse arch that runs along the ball of the foot.

I'm always amazed to see climbers on casual outings wearing their approach shoes. If you're going to squeeze your toes into climbing shoes for hours at a time, at least give them a break when you're not climbing. Cycling shoes are pretty bad for feet, too, but that's another topic.

NaturalFootgear.com has a lot of info on holistic approaches, exercises, and overall prevention. Best of luck! Neuromas suck.

I'll second this.  I suffered from Mortons neuroma for years, to the point where getting my feet into climbing shoes was basically impossible.  I think a combination of climbing shoes and biking shoes initiated the problem, but pausing out both activities didn't help.  Podiatrist wanted to refer me for surgery, but I decided to ditch my daily shoes for wider footwear instead. The pain gradually disappeared over several months and never returned.  On a related note, I also have a really bad case of Haglund's deformity, with huge bony lumps on my heel.  The bumps are gigantic, to the point where I have to cut big holes in my shoe heels (especially climbing shoes) to let the bumps stick out and avoid pain.  Well, I started wearing minimalist shoes, with no heel cup or rigid backing, for both daily wear and running.  After 6 months the bump on one foot completely disappeared, and the other has shrunk by maybe 2/3.