Defeating Morton Neuroma with Open Decompression
I am writing this for those who will see Dr. Peter Bregman in Las Vegas for open decompression for Morton Neuroma. I had a double Decompression Surgery on the Right foot between 2/3 and 3/4. My goal is to help those traveling from afar, locally, and undecided to understand why I chose him and to give tips for traveling to Las Vegas, insurance, and recovery. It may seem like a long post, so you are welcome to jump to the important areas.
To begin, I would like to Thank Dr. Bregman, his staff, and the Hospital staff at Dignity Health at the Nevada Location. Kayla offered professional surgical advice and recommendations to everyone in the office staff for scheduling and explaining the process and charges. The nurse who started my IV, the anesthesiologist, and the recovery staff were caring and medically thorough. All were excellent and professional, and everything flowed naturally.
Decision: I spent thousands of dollars on alternative treatments, including shoes, orthotics, correct toes, and shots that did not work for years; I was spending 15 mins on getting my shoes on to adjust for comfort to do little things like walking the dog. I could no longer work out in my high-impact classes, which affected me mentally. Then in April of this year, something painful happened to my foot pad where I could no longer put pressure on my 2/3 toe area of my foot pad, and those toes began to separate, and I could only wear flip flops to be comfortable. I had enough!
I have been following this Facebook group for Morton Neuroma (MN) to educate myself on treatment options and others’ experiences. I learned about Dr. Bregman (1) Bregman Foot-Ankle & Nerve Center | Las Vegas NV | Facebook from the many compliments he deserves onsite. He also commented on individual posts offering education on his procedures and advised others curious about the proper steps to take. Seeing a physician do such a thing and provide free advice is infrequent! I have been listening to, learning, and watching his YouTube channel Morton’s Nerve DECOMPRESSION Surgery ( no cutting of nerve ) – YouTube for more understanding of his open decompression procedure for about a year. I read about his specific design and self-created craft of stitching and the reviews on Yelp, online, and LinkedIn; you name it, he has excellent reviews from many! I decided to call his office to get scheduled for a consult.
In August, Dr. Bregman met me by telemedicine and being in the medical field, I had many questions. He explained everything in layman’s terms, describing the procedure that would cut the ligament under my toe and clean the scar tissue touching my nerve where the MN rested. I learned that the size of the MN does not matter; if it hurts, do something to treat it. I asked if cutting my ligament would alter my gate, and he explained that it is crucial to have the ligament upon development as an infant, but we will walk normally without it as adults. The combined ligament and scar tissue cause pain when it rubs against the inflamed MN on the nerve. And I was convinced I needed to do this procedure, so at this time, I scheduled myself for surgery in October.
Travel: I traveled by air from Michigan to Nevada with Delta airlines; I upgraded for the return flight to be in first class so I could be near the door and bathroom and more comfortable. (So worth the extra money in this case). I arrived on a Wednesday and traveled home on the following Tuesday. My husband pushed me through the airport by wheelchair to the passenger boarding bridge, where I could use my crutches to get to my seat.
I stayed at the Extended Stay Las Vegas Hotel Near Allegiant Stadium | Residence Inn Las Vegas (marriott.com) -off the strip (about a block). I picked this place because it was closer to the office/hospital and, most importantly, had a kitchen with a large coffee pot, stove, and refrigerator. I travel for a living for my position as an Imaging 3D Advanced Post Processing Education Specialist, so I am familiar with the type of hotels and travel tricks, so if you have travel questions, please ask. We ubered to Wholefoods and shopped for the six days we would be in town. Be sure to load up on water, but if you run out, the exercise room in the hotel has a filtered system you can refill on. This hotel serves breakfast from 6-9 and has some excellent staples (hard-boiled eggs, bagels, breakfast sandwiches, fruit, yogurt, juice, etc.). You will want to pack extra pajamas, Vitamin C, and probiotics, and bring any devices you have already purchased if you have them (Surgical shoe, boot, crutches), Amazon.com: BraceAbility Closed Toe Medical Walking Shoe – Lightweight Surgical Foot Protection Cast Boot with Adjustable Straps, Orthopedic Fracture Support, and Post Bunion or Hammertoe Surgery Brace (M) : Health & Household as it will save you money. I only brought the crutches and the shoe because I never checked luggage, which was easier to transport.
I was unsure if I wanted to rent a car, so I thought I would wait to rent one, but when I decided it might be a good idea, they were sold out due to the number of conventions that weekend. I ended up using uber/Lyft to the places I needed to go, costing about the same as rental/parking fees. So, if you want to have your car, please rent in advance because you never know what’s happening in Vegas. It ended up working for us because we wanted to go down the strip to see some shows before surgery and if you’ve been to Vegas, having a car on the strip is not that convenient for parking because there are lots of parking fees everywhere you go. I recommend seeing the Mob Museum and catching a Vegas or Comedy show! I have learned to bear the pain for so long that I still walked 7 miles the day before surgery. Lol
Insurance: I had my regular fees with Aetna BCBS. I also wanted biologics because I know the positive healing powers of stem cells. There are two types to choose from, and I had to pay $1500 out of pocket (for the one I picked) outside of the other fees because insurance does not cover it, and this fee is based on the availability of the product and costs, so that could vary. There is a processing fee to submit your info to your primary disability financial group from Dr. Bregman’s office. The office requires you to pay 60% of the remaining balance if you still need to meet your deductible. When I arrived at the Hospital before the procedure, the Hospital required me to pay the balance left of the maximum out-of-pocket coverage. However, they will reimburse me for overpayment within 30-45 days after the insurance submission—all pretty standard in the USA.
Pre-op: The day before surgery, you will meet with Dr. Bregman. He did an Ultrasound on my foot to confirm his procedure with what he saw. Before you leave the pro-op appt, be sure you ask for the surgical wash for surgery, they may have it onsite or prescribed along with your antibiotics, pain meds, and nerve pain med. You will need to fill these out on this day. I used the Walmart near the doctor’s office to pick up some extra things and my scripts while I was there. The office can call in the scripts for you. Later that day, the surgical nurse will contact you for the prep, giving you the time to arrive on Friday. Arrival time is about 3 hours before surgery, it is quite a long process to get checked in at the Hospital, and they will want the remainder of your insurance cost.
Recovery Orders: The doctors’ orders are as follows:1. Elevate and ice your foot nonstop for the first 48 hours after surgery. (Having the freezer that made ice was so convenient). 2. For the first week after surgery, you should walk about 30-40 feet per hour to keep things moving (Half of this with two cuts). 3. For the 2nd week after surgery, you should walk about 50-80 feet per hour. 4. Please see if you can get access to a swimming pool to do your rehab after surgery. The best therapy is to walk in a pool about chest high for twenty minutes, at least once a day, every day. If you cannot get to a pool, we will send you to physical therapy. You will not be able to use a pool until 2 or 3 weeks after surgery, after the stitches are out and wounds look closed. (I asked the Doc for permission to use my old shoe and boot and crutches from when I broke my foot, so I could save money from repurchasing it all). If you get stem cells, you will not use ice for the recovery.
Surgical Day into Week 1: My surgery and recovery were incredible. I returned to the hotel, ate something, and rested with my iced foot elevated for 48 hours per doctors’ orders. During the weekend, I tried drinking as many fluids as possible and only got up to eat and use the bathroom. I did not experience any pain during this time. On the third day (Sunday), I wore my shoe and walked around with crutches. I went outside to get some sunshine and fresh air. The temperature in October was refreshing this time of year. I didn’t stay up long, but I did enough to feel refreshed. I ordered this on Amazon.com: TKWC INC Water Proof Leg Cast Cover for Shower – #5738 – Watertight Foot Protector: Health & Household to shower, which worked and felt great! I could immediately tell my 2/3 toes were closer together as they separated from the large painful MN. When Monday came around, I had my post-op appointment, the bandages came off, and man, did that feel wonderful to get some air on my foot. He gave me the stem cell injections (I paid extra out of pocket, and it’s worth every penny). I put my shoe on and headed back to the hotel to rest. You will not use ice after this point if you get stem cells, which also felt great. I flew home the following day and was so tired and swollen after the flight. I went right to bed for the rest of the day.
I felt terrific when I woke on Wednesday, so I put my compression sock and surgical shoe on, walked around the house, unpacked, and even made chicken noodle soup from scratch. After that, I was whooped. I sat on the couch with my foot elevated. I wondered if I overdid things as my foot felt swollen and uncomfortable. I sent the Doc a pic to be sure I was ok, and he said to elevate and relax more. I took a pain med tonight. Thursday, I did less housework, focused on getting my steps in, and did some work on the computer, sitting up for a little bit, then propped my foot up on a chair next to my desk for a couple of hours. Friday, I noticed my foot was pretty bruised up. I still need help putting any pressure on my ball of foot/footpad. I am uncomfortable today and kept my foot elevated most of the day. I cannot walk barefoot at all yet; too painful.
Week Two: I made it through the first week! I must keep telling myself to give it time; the doctor said my recovery would be slower than usual because I have two surgical cuts on the same foot. For the week, I did limit house chores, walked my dog around the property in the boot and compression sock, and rode my bike with my boot (I went very slow and was careful only to use my good foot to anchor as needed). I was sure to take many breaks and elevate my foot to rest. I found that gabapentin is necessary for nerve pain this week as I can feel a weird vibrating sensation in my foot, and the tips of my toes have some nerve discomfort! I met with the nurse by phone mid-week to get instructions on getting my stitches out, other instructions about the follow-up pool physical therapy, and to reorder my meds. I decided to have both the boot and shoe alternate during the recovery. I will keep up this momentum for the rest of the week and try to work out these bruises.
By Thursday, I can stand with pressure on the ball of my foot, and for the first time in six years, I can stand without shifting my foot; for the MN pain. It is gone! Friday, the tape finally came off, my stitches were cut on the ends, and the rest of the stitches will absorb; the wounds look healthy and scabbed over. I gave my foot a good scrub but left the scabs alone (never pick your scabs, it leads to scarring and possibly opening the wounds). I am waiting a couple of days to be sure the wound is fully sealed before I start the pool therapy. I have a more extended swim spa, so that will be used to walk in for 20 mins a day (with the jets off, of course).
Week Three: I am now wearing my boot and compression sock while doing my bike exercise; afterward, I am elevating and relaxing my foot. I have increased sensitivity to the third toe, the one between the two cuts. I checked with the doc to see if this is part of the normal healing process, and he stated it is. My toes still feel swollen, and the nerve regeneration of my tissues has moments of shooting pain to feeling nothing. I must keep reminding myself to be patient, as does Dr. Bregman. By Wednesday, I slowly transitioned into my wide toe box shoe with the insert taken out to give my foot more room. I used my compression sock when wearing my tennis shoes. I am still trying to get a few miles on my bike in a day. I started the pool therapy, and my pain was for sure increasing. I took a pain pill a couple of those nights because I had a throbbing pain in my fourth toe. I took several more elevating breaks during this transition. I am down to 20 pills of gabapentin, and with the doctor’s permission, I will try to wean myself off at this point, taking one a day down from two a day. I had to get instructions, so I am cutting a pill in half and taking the half twice a day.
Pictured above are the day the stitches’ ends were cut on day 14. The following picture is Day 16. The skin is dry. The third picture is day 19; I used a tiny bit of Vitamin E oil right out of the capsule to soften the dry skin around the wound. This week I still have quite a bit of throbbing and nerve pain when I take my first steps in the morning. I must go slow and adjust my foot to move right out of bed. I can still put my whole foot on the floor, and the MN pain is gone, but now I am dealing with nerve regeneration from all the surgical traumas. Pretty standard, I believe.
Week Four: This will be my final entry for a while unless you have more questions. I started Physical Therapy at an Orthopedic Specialist, and if you are from Michigan, I picked one in Ann Arbor. I experienced some tightness after PT this week, probably from the exercises he has me doing, working muscles and ligaments I haven’t used in the last few weeks. Attaching the exercises, he had me do
Next are the few pictures I took this week. My wound has been dry, and I started using a scar ointment. I have been riding my bike twice daily, and today I rode it without my boot. I also took advantage of the 70-degree weather and wore my Rockports.
Finally, if you are considering surgery, consider doing the open decompression, it saves your nerve, and you can feel your toes. Keep in mind I am still healing; it will take months, but it was worth it all. Thank you, Dr. Bregman.
by Shelley Will