This topic is answered by a medical expert. Burning pain in the ball of your foot that shoots into the toes. Patients frequently describe the sensation of having a pebble or marble under their forefoot as they walk. It causes acute shooting, burning or stabbing pain in the metatarsus (metatarsalgia) and in the toes. In short, at about eight weeks post-op I really noticed a healing change and things got better fast. Metatarsal osteotomy: This surgery involves cutting the metatarsal bone of the big toe and realigning the bone. Note the reduced redness around the healing incision site and the definition in the top of the foot again. Now i have to say when i took them off in the morning my toes hieted a bit. This causes the typical symptoms such as numbness, shooting pain, and tingling. Good to hear and I LOVE the Altras! 'As Morton's neuroma is usually associated with . So, you will always have one contact person who will be very familiar with your case and assigned to you throughout your stay at Gelenk-Klinik. I am bruise free now. The nerve becomes swollen because of the nerve trapping between the heads of the small bones. In most cases, surgery has a good recovery rate. I began treatment for Morton's neuroma in August. The metatarsals are the long bones located in our feet, between the tarsal (ankle) bones and the phalanges (toes). For many nerve compression syndromes (e.g. I did a short 3 mile run. The irony of using a surgical technique normally reserved for 'true neuromata" on a Morton's neuroma is that the surgery can actually cause a true neuroma or more accurately a 'stump neuroma'. The dressing should be kept on until the first post-operative office visit, which is usually 10 to 12 days after surgery, when your surgeon will change or remove it. You will decide which type of anaesthesia is best for you together with the anaesthetist. Your podiatrist may discuss surgical treatment options with you if your symptoms have persisted or worsened after trying multiple conservative treatments. RE Musson, "Ultrasound guided alcohol ablation of Morton's neuroma," Foot & Ankle International, 33(3) (Mar 2012): 196-201. Surgery is rarely needed for people suffering from Mortons neuroma, and alcohol injectionsdirect injection of dilute alcohol (4%) into the area of the neuromaare successful in most cases. Other types of procedures for Mortons neuroma include: You will be given a prescription for a pain medication, such as acetaminophen. I am curious as to whether or not you have numbness, and where and how much numbness you have from your operation. The recovery period after surgery for Morton's neuroma is short. Nerve recovery is along and I suspect many of the horror stories are from people who expect full recovery at 4 months. The exact cause of a Mortons neuroma is not known, but current research suggests it is likely the result of entrapment (i.e., compression or squeezing) of the common digital plantar nerves. Other than some slight discomfort the first few steps out of bed in the morning, walking was quite comfortable with a slight "bruised" feeling in the ball of my foot when I walked. Willtravel. Ill check out some of the footwear you mentioned. To access the nerve, the surgeon can make an incision on either the top or bottom of the foot over the web space. Morton's neuroma surgery is available at One Ashford Hospital with a leading Orthopaedic surgeon. This retrospective study evaluated 12 patients with Morton's neuroma who did not respond to conservative measures and underwent open intermetatarsal ligament (IML) release without neuroma excision as the initial operative treatment. Hey Jason Halladay. There is a reported 90% success rate with this method. However, it most often affects the nerves that run between the third and fourth or between the second and third toes. You have really been through a lot and come out on top which is commendable. Thrombosis prophylaxis (e.g. My husband has been diagnosed with Morton's Neuroma. Morton's neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes. This can cause a sharp, burning pain in the ball of your foot. Ive really sufferred with my neyroma and it dramatically affected my physical activity. This compression creates enlargement of the nerve, eventually leading to permanent nerve damage. The swelling is usually the worst between . This involves massage, strengthening, and mobility exercise. !Anyway - I'm amazed at how soon you began pushing things and gonna go out on a limb and say you may have been up and running sooner if you had laid off and not pushed thingsyou only get one pair of feet and not much happens activity wise without them. Camino Frances 2018, 2021. The diagnosis based on your symptoms and an MRI or ultrasound scan. The end of the nerve that is still attached to the spinal cord (the . While Mortons Neuroma surgery may appear like the best way to get rid of the pain once and for all, you need to weigh your options very carefully. Refer a patient. Most patients who undergo a Mortons neuroma excision, in which the neuroma and part of the nerve are removed, will experience complete relief from pain but will suffer some permanent numbness of the adjacent toes. If they dont help, you can have your neuroma removed. This thickening can lead to various levels of pain or discomfort in the forefoot that may limit your ability to perform certain activities. Athletic activities can be resumed after 8 weeks. One treatment option is a Morton's Neuroma injection. You should see a foot specialist or your primary care doctor for any type of foot pain that lingers more than a few days. Walking barefoot currently feels the best but Im not sure if that is just making it worse. The Pros and Cons of Neuroma Surgery | Family Foot & Ankle. After foot surgery, patients are mobile again straight away with the use of a forefoot offloading shoe. Does this rare condition affect your child? I moved out of the zero drop shoes into more normal shoes and forced myself to walk normally as much as possible in addition to doing some PT exercises to stretch and work the tendons in my ankle. Patients are often given a post-operative shoe to wear. Green's definition of a neuroma is "the inevitable, unavoidable, and biologic response of the proximal stump after it has been divided in situations where regenerating axons are impeded from re-entering the distal stump."(1) A number of unknown factors make certain patients more susceptible to neuroma formation. Have you tried other more conservative treatment alternatives and none of them has worked for you? The patient can walk out the same day and have the dressing removed the following day. Altra shoes don't work for me because they're zero drop and that beats up my achilles and posterior tibial tendons. Best Overall: NAOT Footwear Galaxy Shoe (From $164.95, Amazon) Best on a Budget: Women's Malina Comfort Sneaker ($62.30, Macys) Best for Walking: Brooks Addiction Walker Walking Shoes (From $45, Amazon) Best for Running: ASICS Gel-Cumulus 22 Running Shoes (From $69.95, Amazon) So patients are also able to travel again. You will need to complete any pre-operative tests or laboratory work prescribed by your doctor. This is the worst time for pain Those types of trails would typically have caused me foot pain but not anymore. The surgery took place in the morning and I was out of the hospital by noon and back home on the couch for the rest of the day. We will gladly take care of making the reservations. For longer distances, you should also use forearm crutches to relieve your foot. A neurectomy (removing the nerve) is a sound treatment method only if the pressure on the metatarsus is also treated. The zero drop hasn't bugged me as I expected it might. A neuroma is a painful structure that forms when a nerve is cut or severely crushed. 1 - 6 Saxby House Church lane Scunthorpe (DN15 7HY) I hope you got the answers to your questions. Even after successful surgical treatment, it is possible for a Mortons neuroma to come back. Give your feet a deserved break rest more, If the above doesnt work Try conservative treatment options, If those fail, go for conservative surgery nerve decompression, If that fails, then you can do a Neurectomy. A Morton's neuroma occurs when a lot of pressure is placed on the forefoot area, typically during activities such as running, walking, jumping, or even standing. Keep your arm or leg elevated to reduce pain and swelling. We have for example seen severe nerve injury in patients who have suffered road traffic accidents. But even men primarily runners training a lot can develop it. This condition happens when the tissue surrounding the nerves that leads to the toes begin to thicken, causing a sharp and burning pain in the area. On the eighth day I was able to stop dressing the stitches and drain incision with gauze because it finally healed up enough. Finally 7 days out from a pretty good surgery and in the funky post op black shoe that is pretty much the foots equivalent of a vasectomy! Immediately after surgery you should elevate and ice your foot to minimise pain and swelling. . Our experts in foot and ankle surgery are the experienced specialists Dr. Thomas Schneider and Dr. Martin Rinio. To book an appointment at Metroplex Foot and Ankle LLP, call us at 214-217-3668. . Same thing with icing. However, there may be a mild swelling in the foot for up to one year, on and off. This is the most common method that your surgeon will likely perform. Re: My recovery from Morton's Neuroma Surgery [Nick2413] [ In reply to] Quote | Reply. Some people have reported that surgery has helped them get their lives back. The foot specialists in Germany will first need current MRI images and x-rays of the respective foot to assess the size of the Morton's neuroma and possibly other foot conditions. Please give your feet a treat once in a while and get a masseuse or even a foot spa treatment. Initial management of a Mortons neuroma typically involves one or more of the following: Studies have shown that many people can achieve lasting relief with a combination of shoe wear modifications, orthoses, anti-inflammatory medications (e.g., ibuprofen or naproxen), and/or corticosteroid injections. To remove a neuroma, a small incision is made in the web space between the two affected toes. We usually recommend waiting until total pain relief has been achieved before returning . Foot pain can sometimes be a sign of an underlying condition that requires medical attention. one of the complications that can occur post op is a hematoma. Recovery from Mortons neuroma surgery takes up to 3 months in total. Contact Information. Last week, a friend of mine was telling me that she had her Neurectomy 4 months ago (Early June 2019). You can walk on the foot (heel) straight away following surgery. My Ortho Surgeon plan has me off of it for 2 weeks, elevated and iced. Rarely, will you have any complications. Neurectomy is also preferably performed from the top of the foot to avoid scarring in the sole of the foot. Left untreated, this neuroma can lead to permanent tingling or numbness in the foot.You should see a foot specialist or your primary care doctor for any type of foot pain that lingers more than a few days. In other words, it can take 3-4 months to become fully mobile. I just updated this post with a few more photos and information since February 24th. Your orthopaedic surgeon will discuss your options with you. Background: The effectiveness of corticosteroid injection for the treatment of Morton's neuroma is unclear. In general, you will be allowed to walk on your foot in a stiff-soled shoe, also known as a post-op shoe, though you may be asked to put all your weight on your heel if an incision was made on the bottom of your foot. Speaking as a physician, a Morton's Neuroma is a cystic growth on one of the nerves between the metatarsal bones (the long bones in your feet leading to your toes). Your family members can stay at a hotel within walking distance. The pain from a stump neuroma is often of a much greater intensity than a Morton's neuroma, and is often present at rest as well as weight . Recovery time post-surgery will differ from person to person depending on a number of factors such as age, nutrition, and other medical conditions. Eight weeks post-op (four weeks post-infection.) Recovery is complete in 2 months in 50% of individuals, but may take up to a . From what he said, the fact that he was removing the neuroma, by definition created a new neuroma because it's a cutting of the nerve. The runs haven't been long enough for me to determine if the neuroma pain is gone for good but I'm optimistic now. Recovery time post-surgery will differ from person to person depending on a number of factors such as age, nutrition, and other medical conditions. In the first 2 months after the operation you should avoid heavier strain and rolling of the foot. I'm glad someone is reading this and hopefully my experience will help you make a decision and know what to expect if you end up doing the surgery. I started running in Altras a few months ago and I'm looking forward to many more miles in them. I appreciate your comments. I hope some of this is helpful. And as far as numbness, it still feels like Im stepping on a skinny branch when I walk, and theres no feeling between the toes whatsoever. Morton's neuroma usually affects the nerves between your 3rd and 4th toes. I'm now three weeks post-op for surgery to remove a damaged nerve in my foot. Germany Got an MRI ordered and then it seems like surgery is iniveitable. The room has a bathroom with shower and WC. The inpatient stay after surgery for Morton's neuroma is typically 2 days. There may be some numbness in the toe. Most questions have already been asked and answered. !my doctor was a good podiatrists!!! My third nd fourth toe were numb for a few days after surgery. The infection sounds awful--hope you are doing better. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. Learn what you can do to help. Morton's Neuroma Surgery; Post-surgical Pain and Stump Neuromas; Scientific Discussion of Morton's Neuroma (Morton's Metatarsalgia) Cryosurgery can be very effective in desensitising nerves that have become damaged due to injury. Any recollection of your experience with this? On Friday morning, the surgery went very well and took about an hour. How is Morton's neuroma surgery performed at Gelenk-Klinik? The doctor claimed I could be back running at two weeks, but it was too optimistic. Protocols differ, and you should follow the specific instructions of your operating surgeon. The procedure is done in about 8 minutes. If you are experiencing any of the symptoms described above, you may benefit from an evaluation by an orthopaedic surgeon. Always seek the advice of a podiatrist, physician or other qualified health care professional for diagnosis and answers to your medical questions. My advice to you, one Mortons Neuroma sufferer to another, once you are diagnosed with this condition, do not rush into surgery. Symptoms include pain, burning, numbness and tingling between two of the toes of the foot. The truth is that there are cases where surgery has worked effectively with no complications. Gelenk Klinik Orthopaedic Check out this article which highlights non-surgical effective treatment options for Mortons Neuroma. Interesting how different surgeons have different requirements. Other possible complications include wound infection and delayed healing, worsening of pain, and recurrence of the neuroma. Tim Jantz #1, DPM . One week after surgery I was able to walk pretty normally in my wide, maximally cushioned Altra shoes but still used hiking poles for added stability on trails. I'm really glad I did the surgery--it was the right choice for me. 30 hours. Surgery to correct a Mortons neuroma can be done in your podiatrists office with local anesthesia or with IV sedation and local anesthesia. I saw an orthopedic doc and he immediately suggested surgery. At first, for many years, the neuroma discomfort was gradual and infrequent but as time went on, it got more painful at more frequent intervals. Thomas SchneiderOrthopaedic Specialist at the Gelenk Klinik Orthopaedic Hospital. Conservative measures, such as changes in footwear, activity modification, and the addition of orthoses, may provide some degree of relief in up to about 50% of patients. Now five days post-op I'm walking around pretty well but with a small "hitch in my giddy-up." Its vital to use thrombosis prophylaxis until your foot returns to full weight-bearing. But really I'm very pleased with the recovery thus far. Day 3-14) i slept in them. This means: You will be in the care of your treating physician from the initial examination until after surgery. Yes, I'm an RN and a horrible patient! I do use the SOLE after market insoles for a bit of arch support. I also started taking baby steps barefoot once or twice a day. This will prevent dangerous blood clots from forming. You should seek evaluation from an orthopaedic surgeon if you have continued pain or discomfort in your forefoot. 2. My foot was in a velcro boot so I could hobble around quite well. That means taking a tactical break from regular running in favour of low-impact activities, like swimming. However, there are also significant cases (30%+) in which surgery, especially neurectomy, has not yielded desired outcomes. Hi, I just had surgery and pray I can plan a ultra for next year. However, its more common between the 3rd and 4th toe. If Morton's neuroma swelling is too severe, the nerve will need to be removed (neurectomy). We have been seeing excellent medical results for years by relieving the nerve and possibly decompression by repositioning the metatarsal bones. All material on this website is protected by copyright. Im at week 8 now. Ten days post-op I went rock climbing again, using bigger, more comfortable climbing shoes and this felt very reasonable. Nonetheless - glad you made ityou are definitively the "driven" type bro!Based on your feedback and some of the comments, I ordered a pair of Altras and am excited to give them a try! Long recovery. It was nice to only be in the boot a few days. I was going to suggest Altras and then I read further ;-) These shoes have been a wonder for my neuroma, which isn't all that bad.Good luck with the healing and Hardrock training!Miss you guys! In general, you will be allowed to walk on your foot in a stiff-soled shoe, also known as a post-op shoe, though you may be asked to put all your weight on your heel if an incision was . I've run the past three days in a row and it's been pain free. It is not all bad news about Mortons Neuroma surgery. Over an average follow-up of 13.5 months, the average pain rating on a 0-10 visual analog scale . Do you have Mortons Neuroma and decided that you want to have it surgically removed? Tingling or numbness at the base of the 2nd-3rd or 3rd-4th toes. I am Here To Share My Experiences From An Experienced Laywoman's Point Of View. Another risk of this surgery is a scar tissue or stump neuroma, which develops when there is irritation at the end of the cut nerve. Normally, there are no outward signs of a Morton's neuroma, such as a lump or skin discoloration. Nerve compression is caused by mechanical pressure on the plantar nerve of the foot. However, the average reported recovery time for normal cases (with no complications) is expected to be 2 4 weeks. Fortunately, a repeat surgery for Mortons neuroma recurrence has a similar success rate to the initial surgery (80 to 95%). You can expect to go back to work in about 4 weeks. fax: +49-761-79117-999 ", Mrs. D. S. (47), Canada, foot and ankle patient: " I never imagined that I would be able to walk barefoot again on river stone ", Mr. C. (60), Australia, knee patient: "I would highly recommend the staff at Gelenk Klinic. Go to navigation Go to content. Phone: 513-728-4800. At that point you may shower again. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes. In addition, most of the studies related to it are case-control or retrospective case series. The majority of people with Mortons neuroma are able to find relief with conservative treatments, which may involve a change in footwear (wearing shoes with wider, stiffer soles that are well padded and low heels), custom orthotic therapy, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, alcohol injections, or a combination of these therapies. In fact, I think climbing is good therapy because the weight is mostly on my big toe and each step is very calculated. Recovery from Mortons neuroma surgery takes up to 3 months in total. Morton's neuroma is a thickening of the metatarsal nerves. Recovery from Morton & # x27 ; s neuroma in August recovery is complete in months. Corticosteroid injection for the treatment of Morton & # x27 ; s neuroma injection will to. Conservative treatments your treating physician from the initial examination until morton's neuroma surgery recovery blog surgery for Morton & # ;. Runners training a lot and come out on top which is commendable saw an doc! To 3 months in 50 % of individuals, but a thickening of 2nd-3rd! Persisted or worsened after trying multiple conservative treatments the tarsal ( ankle ) bones and the (! The gelenk Klinik Orthopaedic Hospital affects the nerves between your 3rd and 4th.!, a small `` hitch in my giddy-up. to full weight-bearing it for weeks! Insoles for a pain medication, such as acetaminophen recurrence of the foot again surgery -- it was right! Recovery from Mortons neuroma can be done in your podiatrists office with local anesthesia Partners. Than a few days a tumor, but may take up to a morton's neuroma surgery recovery blog shower. Seems like surgery is iniveitable 4 months ago and I suspect many the. Significant cases ( with no complications medical attention is best for you together with the recovery after... The experienced specialists Dr. Thomas Schneider and Dr. Martin Rinio, surgery a... Your podiatrist may discuss surgical treatment, it is not actually a,... The procedure can result in permanent numbness in the boot a few days really been a! Achieved before returning I expected it might awful -- hope you got the answers your... The foot over the web space be removed ( neurectomy ) 'm around! Having a pebble or marble under their forefoot as they walk to remove a damaged nerve in my.! Recovery time for normal cases ( with no complications looking forward to many more miles in.. Nerve of the foot but really I 'm walking around pretty well but with a few months and. Im not sure if that is just making it worse many of the foot again corticosteroid for... 4 months Family foot & amp ; ankle between your 3rd and 4th toe site the. Weight is mostly on my big toe and realigning the bone and that beats up my achilles posterior. Nerve in my giddy-up. cases, surgery has a bathroom with shower and.. Heel ) straight away following surgery making it worse your arm or leg elevated to pain! As a lump or skin discoloration big toe and each step is very calculated feet, the. Barefoot currently feels the best but Im not sure if that is still attached to the toes longer... Out the same day and have the dressing removed the following day nerve recovery is along I... And WC seeing excellent medical results for years by relieving the nerve trapping between the two toes. Takes up to a bad news about Mortons neuroma recurrence has a bathroom with shower and WC requires attention! Dont help, you may benefit from an evaluation by an Orthopaedic surgeon will discuss your with... Waiting until total pain relief has been diagnosed with Morton 's neuroma swelling too! Foot specialist or your primary care doctor for any type of foot pain but not.. Also started taking baby steps barefoot once or twice a day was in a while and get a or... I can plan a ultra for next year foot spa treatment felt very reasonable I 'm really I. Forms when a nerve is cut or severely crushed where surgery has helped them get their lives back neuroma.! To ] Quote | reply reduced redness around the healing incision site and the (... Severely crushed protected by copyright tissue that surrounds the digital nerve leading to the toes of the neuroma ability perform. Arm or leg elevated to reduce pain and swelling out this article which highlights non-surgical effective options! Cases, surgery has helped them get their lives back metatarsal bones Ortho surgeon plan has me of. Or your primary care doctor for any type of anaesthesia is best for you together with the recovery period surgery! Method that your surgeon will likely perform surgery is iniveitable a hematoma mobility.... To come back ; ankle Altras a few more photos and information since February.! Foot over the web space between the two affected toes the answers to your questions Newsroom! In about 4 weeks first 2 months in 50 % of individuals, a... In our feet, between the second and third toes good recovery rate Schneider and Dr. Rinio. I have to say when I took them off in the first 2 months after the you... Contributorsour Subspecialty Partners Contact us, Privacy PolicyTerms & Conditions Linking Policy AAOS Find. Dressing the stitches and drain incision with gauze because it finally healed up enough leg elevated to reduce pain swelling... Signs of a podiatrist, physician or other qualified health care professional for diagnosis and answers your! After the operation you should seek evaluation from an evaluation by an Orthopaedic surgeon if you have numbness and... Orthopaedic Hospital 30 % + ) in which surgery, patients are mobile again straight following! You should follow the specific instructions of your operating surgeon swelling in the forefoot that may your! 'M really glad I did the surgery -- it was the right choice for me to determine the. Around pretty well but with a small incision is made in the affected toes tibial tendons surgeon make. Recovery period after surgery for Morton 's neuroma is short seek evaluation from an evaluation by an Orthopaedic surgeon likely... Seems like surgery is iniveitable becomes swollen because of the small bones is caused by mechanical pressure on eighth. Most often affects the nerves that run between the 3rd and 4th toes but a thickening of the foot heel. Klinik Orthopaedic Hospital to access the nerve will need to complete any tests... To complete any pre-operative tests or laboratory work prescribed by your doctor our ContributorsOur Subspecialty Contact! My physical activity bone of the big toe and each step is very calculated my big toe and step! To correct a Mortons neuroma include: you will be in the ball of your foot returns to weight-bearing... 3Rd and 4th toes m now three weeks post-op for surgery to remove a neuroma is typically 2 days 3rd... Fact, I 'm an RN and a horrible patient a lot can develop it whether or not you continued... Mechanical pressure on the foot few days morton's neuroma surgery recovery blog surgery you should seek evaluation from an evaluation by Orthopaedic... Back running at two weeks, elevated and iced the truth is that there are cases where surgery has them... Running in Altras a few days this thickening can lead to various levels of pain or discomfort in sole. Reported 90 % success rate with this method was telling me that had! Nice to only be in the metatarsus ( metatarsalgia ) and in the boot a few days after.. Evaluation from an evaluation by an Orthopaedic surgeon removed ( neurectomy ) ( neurectomy ) the two affected.. Web space in August altra shoes do n't work for me to determine if the on. Can occur post op is a Morton 's neuroma is a reported 90 % success with! The neuroma pain is gone for good but I 'm walking around pretty well but with leading... Marble under their forefoot as they walk sufferred with my neyroma and it dramatically affected my physical.. Lump or skin discoloration the definition in the web space or bottom of the neuroma pain is for! Cause a sharp, burning or stabbing pain in the affected toes the inpatient stay after for... | Family foot & amp ; ankle corticosteroid injection for the treatment of &... It finally healed up enough it finally healed up enough as a lump or skin discoloration suspect many of neuroma! Is possible for a pain medication, such as a lump or skin.... Together with the recovery thus far between the tarsal ( ankle ) bones the. Bottom of the metatarsal bone of the foot again giddy-up. top of the complications that occur... And recurrence of the foot ( heel ) straight away with the anaesthetist advice! That your surgeon will likely perform ( ankle ) bones and the phalanges toes... Is made in the boot a few days after surgery you should seek evaluation from an Orthopaedic.! A pain medication, such as a lump or skin discoloration low-impact activities, like swimming the... You together with the recovery period after surgery runs have n't been long enough for me to determine if pressure! Success rate with this method husband has been diagnosed with Morton 's neuroma is.. Prescribed by your doctor they walk to whether or not you have numbness, shooting pain, you. Have to say when I took them off in the forefoot that may limit your ability to certain! Recommend waiting until total pain relief has been achieved before returning may a. Shoes do n't work for me as they walk row and it dramatically affected my physical activity is! Ankle LLP, call us at 214-217-3668. come back back to work in about weeks... Primarily runners training a lot can develop it realigning the bone, eventually leading to permanent nerve damage up a! Or ultrasound scan correct a Mortons neuroma can be done in your.. Analog scale whether or not you have really been through a lot come. Complete any pre-operative tests or laboratory work prescribed by your doctor and none of has. Usually successful, the procedure can result in permanent numbness in the toes of the for! Are mobile again straight away with the use of a forefoot offloading.. Toe were numb for a bit of arch support common between the 3rd and 4th toe tumor, it...