Neuroma refers to a benign growth that can occur in different parts of the body. A special alcohol solution is injected over the nerve. Accessibility I've been coming to Dr. Briskin ever since my son was in elementary school (he's now 29). Santiago F.R., Muoz P.T., Pryest P., Martnez A.M., Olleta N.P. Conclusion: New York Bone & Joint Specialists is now open for IN-PERSON and TELEHEALTH appointments. Mortons neuroma is a thickening of the nerve between the third and fourth toes. After years of research and studies, done by us and others, we have learned that burying the nerve into the arch musculature dramatically reduces stump neuromas and post-surgical problems. Bencardino J., Rosenberg Z.S., Beltran J., Liu X., Marty-Delfaut E. Mortons neuroma. In some cases, there also is the sensation of a lump, a fold of sock or a "hot pebble" between the toes. However, all were small studies with short term follow up, and only weak evidence for their use and are therefore not recommended by the authors.31, 32, 33, 34, 35, 36, 37, The neuroma can be excised by two methods, either a dorsal or plantar approach. Freeze a water-filled paper The Department of Neurosurgery is pleased to offer one- and two-year fellowship training programs. A wider toe box can alleviate the pressure, so avoid narrow-toed shoes. Imaging of Arthritis and Metabolic Bone Disease. Injections and surgery tend to take care of the issue. TheCenter for Mortons Neuromatreats more Mortons neuroma patients than any other place in the country. Make Appointment. Come see us today! Always seek the advice of your physician or other qualified health provider before starting any new treatment or with any questions you may have regarding a medical condition. Morton's neuroma (MN) is an entrapment degenerative neuropathy with a strong predilection for the 3rd interdigital web space. Copyright 2019 European Foot and Ankle Society. Dorsal approach for Mortons Neuroma excision. Repetitive, heavy impact on the feet, for example during running, dancing, or athletics. The treatment options are: orthotics, steroid injections and surgical excision usually performed through dorsal approach. Physical therapy is another very effective treatment for neuromas in their early stages. Stretching and Massage. Biz C, Bonvicini B, Sciarretta G, Pendin M, Cecchetto G, Ruggieri P. J Clin Med. Bourke G., Owen J., Machet D. Histological comparison of the third interdigital nerve in patients with Mortons metatarsalgia and control patients. Anti-Inflammatory Injections for Pain Management Another form of natural treatment for your Mortons Neuroma are anti-inflammatory injections. Our therapists, doctors, and staff will track your progress, send you appointment reminders, and always give you the best attention and orthopedic care in the New York area. Disclaimer, National Library of Medicine Orthoses or custom shoe inserts can help relieve stress on one area of the foot by distributing force evenly and we recommend these after ablation treatment. Background: All Did helped but did not cure: -I got cortison shots on both It is dependent on size of the neuroma and is usually positive in Mortons neuroma measuring 1cm or more.5, A baseline weight bearing radiograph will aid in the exclusion of other causes of forefoot pain and give an overview of the osteology. Keywords: The mechanism of action is breakdown of scar tissue and adhesions. [. Characterized by a swelling of tissue surrounding one of the nerves that leads to the toes, it can feel like standing on a pebble in your shoe. Through a rapid and limited deep-freezing of the affected area, the chronic pain that damaged nerves cause is resolved with a simple and comfortable office procedure. In extreme cases, the drugs that will be administered in the Mortons neuroma treatment are temporary pain medications. Muramatsu K, Tani Y, Seto T, Arcinue J, Iwanaga R, Sakai T. J Hand Microsurg. We bury the nerve into a muscle with neuroma surgery which has significantly reduced the stump neuroma issue (a condition when nerve tissue is severed and tries to regrow). Alcohol showed promising short-term pain-relieving results only. When these bones compress together, due to tight shoes like high heels, high-impact activities, or foot deformities, the nerves between the joints become swollen, irritated, and inflamed. Other symptoms include stinging, burning, or numbness. If a particular activity is causing the injury, you will need to stop that activity, at least long enough for it to heal. It is a common pathology affecting the forefoot. 17% of patients describe some trauma to the foot resulting in symptoms.5 The most common characteristic of the pain is burning in nature. The most sensitive clinical tests for the diagnosis of Mortons neuroma are the thumb index finger squeeze test, Mulders click test and foot squeeze test in that order. This is caused secondary to pressure or repetitive irritation leading to thickness of the nerve, located in the second or third intermetatarsal space. professionals unless a clear statement is made that a piece of advice offered Typically, both sides of the body are involved, and the initial symptoms are changes in sensation or pain often in the back along with muscle weakness, beginning in the feet and hands, often spreading to the arms and upper body. If you prefer to call us directly to book the appointment then we would be happy to take your call. This can cause pain when walking. Ultrasound scan showing Mortons Neuroma (bold arrow). orthotics, and general foot consultations. Conveniently located on theUpper East SideandMidtown Manhattan, we are available whenever and where ever you may need. Your Podiatrist will attempt to remove the causative factors. 2021 Jun 7;21(85):e134-e138. A soft-soled shoe will also be recommended. Mulders click test is performed by dorsiflexing the foot and squeezing the metatarsals. Here is what cured it for me and what did not. 2. Their results suggested that 82% of patients who received 23 steroid injections reported complete satisfaction at 12 months.18, Corticosteroid is currently the mainstay of injection treatment for Mortons Neuroma. Received 2020 Feb 27; Revised 2020 Mar 25; Accepted 2020 Mar 26. Please enable it to take advantage of the complete set of features! 1220 W 1st St, Ste B, Centralia, WA 98531. Our team is here to help you make an appointment with the specialists that you need. Patients find that under the guidance of our foot surgeon, their condition improves drastically with orthotics, injection therapy, and simple lifestyle changes. Can Overview | Radiofrequency Ablation for Symptomatic Interdigital (Mortons) Neuroma | Guidance | NICE. about navigating our updated article layout. eCollection 2022 Jul. Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Epub 2020 Nov 7. Corticosteroid injections can relieve nerve inflammation and pain associated with neuromas. Over time, the continued compression and irritationof the nerve will cause more severe damage to the nerve and lessen the success of conservative treatments. Dr. Bob Baravaria DPM, FACFAS is a Board-Certified Podiatric Foot and Ankle Specialist. Fortunately, acupuncture treatment is an excellent way to help relieve nerve pain. Other symptoms may include tingling and numbness in your toes, sharp or burning pain from the ball of the foot to your toes and pain while standing or walking. A Morton's Neuroma is a neuroma that's causes foot pain in the ball of the foot (usually between the third and fourth toes). Any medical or health advice provided and hosted on this site will only be given by medically trained and qualified Plantar callosities around metatarsal heads are suggestive of transfer metatarsalgia, synovitis, subluxation or dislocation of metatarso-phalangeal joint of 2nd or 3rd toes. Steroid injections numb nerves without making permanent changes to your foots structure. The mean diameter was 4.1mm in the asymptomatic group compared to 5.3mm in the symptomatic group.10 The diagnosis of Mortons neuroma is relevant only when the transverse diameter on an MRI scan is 5mm or more and can be correlated to clinical findings.11 Sharp et el reviewed 29 cases and found no correlation between size and severity of symptoms.8 A prospective randomised controlled trial demonstrated no statistically significant difference in the mean size of neuromas that responded to treatment with steroid injections (11mm), compared to those that did not (12.5mm). Musson R.E., Sawhney J.S., Lamb L., Wilkinson A., Obaid H. Ultrasound guided alcohol ablation of mortons neuroma. Dellon and Mackinnon described a technique of implantation of the nerve stump within the muscle. Mortons neuroma is a common cause of forefoot pain. It is also known as Mortons neuroma and can be made worse by: tight, pointy, or high-heeled shoes; shoes or trainers that put excessive pressure on the ball of your foot and toes. Mahadevan D., Venkatesan M., Bhatt R., Bhatia M. Diagnostic accuracy of clinical tests for mortons neuroma compared with ultrasonography. What Morton's neuroma is and how to treat it Medically reviewed by Angela M. Bell, MD, FACP Mortons neuroma is a painful but benign growth of nerve tissue in the foot. Although multiple studies report good patient reported outcomes, they have all been small, retrospective in design, with short term follow up. Corticosteroid showed a statistically significant reduction in mean VAS over all their studies (p < 0.01), with 50% success at 12 months. She was very caring and thoughtful and took the time to answer all my questions Great doctor's, I loved Dr. Franson. Morton's Neuroma appointments are guaranteed and free! Mann R.A., Reynolds J.C. Interdigital neuroma - a critical clinical analysis. An x-ray may also be ordered to make sure no other issues exist in the foot. doi: 10.7547/20-151. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. As a non-invasive treatment it is therefore one of the best options for treatment of a Mortons neuroma, and why we use this approach extensively in the Foot & Ankle Clinic in Darlington. It is not a true neuroma but is fibrosis of the digital nerve. The most common intermetatarsal nerve to suffer from neuroma is the 3rd intermetatarsal nerve or Mortons nerve. Charcot foot, also called Charcot arthropathy, is a disease that attacks the bones, joints, and soft tissue in your feet.When it starts, you may not realize somethings wrong. Get a good orthotic that takes pressure off the ball of your foot. Altered sensations and feeling a pebble in the shoe is reported by more than 50% of patients. A local anesthetic injection along the neuroma may temporarily abolish the pain, and help confirm the diagnosis. Splaying of toes is a good indication that the test has been performed appropriately. [. Mortons neuroma is a common neuropathy of the common plantar digital nerve, usually causing pain between the third and fourth toes. Dont wait for your condition to get worse, contact The Center For Mortons Neuroma today. This maneuver usually reproduces the patients pain. Bunions; Bursitis; Capsulitis; Haglunds Deformity; Hallux Rigidus; Hammertoes; Gout; Harpaz is an experienced podiatric physician with a passion for combining traditional podiatric remedies with holistic treatments. Careers. Positive test results in pain in presence of Mortons neuroma. I highly recommend you see a Podiatrist to have these treatments performed. 2021 Jul 1;111(4):Article_13. If your shoes are contributing to the problem, you will need to wear different shoes. Researchers measured changes in patient pain, function, and neuroma size. Mahadevan D., Attwal M., Bhatt R., Bhatia M. Corticosteroid injection for Mortons neuroma with or without ultrasound guidance A RANDOMISED CONTROLLED TRIAL. Although Orthobiologic Cell Therapy is considered by some people to be experimental, various research studies show that some marrow aspirate concentrate and platelet rich plasma injections may provide excellent relief from joint and musculoskeletal pain and ongoing inflammation. Book your appointment. Seok H., Kim S.-H., Lee S.Y., Park S.W. All other foot nerve enlargements of the 1st, 2nd and 4th intermetatarsal nerves are simply referred to as a neuroma. It is your ultimate guide to reliable health information on common topics from A to Z. Statistics were combined across cohort studies to calculate pooled mean results, and improvements in outcomes. If neuromas are treated early, conservative treatment is usually successful. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Radiofrequency ablation Radiofrequency ablation disables the nerves causing pain with a radiofrequency energy probe. However, no studies have proven benefit over one or the other.15, The plantar approach is less commonly used and success following removal has a broad range from 51% to 85%.38, 39, 40, 41 Wolfort etal. Mortons Neuroma is the most common neuroma, affecting a nerve at the spaces between the ends of the metatarsal bones where they come in close proximity (called metatarsal heads). Care must be taken in diagnosing Mortons neuroma. This includes cortisone with a local anaesthetic. There are a number of studies looking into the use of ethanol/alcohol injections into neuroma, which show improvement in patient reported outcome measures at 12 months and reduction in neuroma size.21, 22, 23, 24, 25, 26, 27 This included one study at 5 years by Gurdezi, which followed up on the previous study by Hughes etal.22,27 Although the 12 month outcomes were promising with 84% patients reporting complete resolution of symptoms, at 5 years this was the case in only 29% of patients. MRI and ultrasound are imaging studiesthat can demonstrate the presence of the neuroma. Damage to peripheral nerves may impair sensation, movement, gland, or organ function depending on which nerves are affected; in other words, neuropathy affecting motor, sensory, or autonomic nerves Treatments. Patients sometimes get pain relief by wearing lower-heeled shoes (as in NOT high-heels) and shoes with a wide toe box. Steroid injections may reduce pain and swelling. It's strange to say about medical appointments, but I always find a visit to your Westlake office to be uplifting. J Foot Ultrasound Guided Radio Frequency Ablation, Ultrasound guided non-surgical procedures. Treating and Managing Mortons Neuroma Self-Treatment Options to Improve Symptoms Decrease the compression by wearing 1-2 size bigger shoes to decrease the compression. The nerve that runs between your toes will swell and thicken. UFAI's offers the latest diagnostic and curative treatments available. reported that orthotics on their own were not very helpful. Our team of dedicated access representatives is here to help you make an appointment with the specialists that you need. As your nerve becomes enlarged, it will experience further compression which causes symptoms such as numbness, tingling and sharp shooting pains to be felt down the adjacent toes. It has been reported that clinical assessment by experienced clinician has up to 98% accuracy as compared to an ultrasound (USS) examination.5. MRI is safe and painless. The information provided on this site is designed to support, not replace, the relationship that exists Again, the shockwave therapy group showed significant difference before and after therapy, whereas the sham group had no significant difference. Decrease or eliminate weight-bearing activities. Mortons neuroma is a condition that usually develops between the third and fourth toes, but can cause pain in other toes as well. Since 1995, Dr Hess has dedicated his time and fed his passion for Podiatric Medicine in the Northwest to improve the lives of his Treatments Anti-inflammatory drugs may be recommended to dull the pain and In addition, this procedure stimulates the creation of new blood vessels which promotes healing. Morton neuroma occurs when two bones rub together and squeeze the nerve between them. Neuromas are thickened portions of nerve that can cause discomfort and pain. Orthotics, Capsaicin injections, Cryoablation, Botulinum toxin, RFA and ESWT did show statistically significant improvements, but with limitation to their application. Pain. Morton neuroma is a buildup of benign (noncancerous) tissue in the nerves running between the long bones of the foot. 5 Ways to Connect Wireless Headphones to TV. 2).8,9. Athletes and people with low or high arches, bunions or hammer toes commonly get neuromas. Journal of Clinical Orthopaedics and Trauma, http://www.ncbi.nlm.nih.gov/pubmed/8722878, http://www.ncbi.nlm.nih.gov/pubmed/10919620, http://www.ncbi.nlm.nih.gov/pubmed/7516653, http://www.ncbi.nlm.nih.gov/pubmed/14516035, http://www.ncbi.nlm.nih.gov/pubmed/19448168, http://www.ncbi.nlm.nih.gov/pubmed/14917717. Injection therapy. government site. Before sharing sensitive information, make sure youre on a federal There are a variety of non-surgical treatment options. It is important to make sure that the pressure is exerted in the intermetatarsal space and not in the metatarsophalangeal joint itself. Thank you for choosing New York Bone & Joint. Mortons neuroma involves thickened tissues compressing nerves between the toes. The following measures will often help improve metatarsalgia and stop it coming back: Athletes are also prone to having Mortons neuroma if their sport involves high-impact activities with intense stop-start movements. joint and foot conditions including arthritis, gout, bunions, bursitis, Morton's neuroma, hammer toes, and stress fractures; Metatarsalgia is also more common in older people and people with diabetes. We are committed to providing our patients with the most appropriate non-surgical treatments for their Mortons Neuroma. NEW!Telehealth Resource Center. We and our partners use cookies to Store and/or access information on a device. Try ice massage. 303-805-5156 About; Doctors; From there, she attended SUNY Buffalo to earn a Masters degree in nutrition, and then podiatry school at the New York College of Podiatric Medicine. He is an assistant clinical professor at the UCLA School of Medicine and serves as Director of University Foot and Ankle Institute. HHS Vulnerability Disclosure, Help Mortons Neuroma. If these remedies do not work to alleviate symptoms, the doctor may give special devices to separate the toes and avoid the squeezing of the nerve. Explains everything and provides good treatments. This solution has an affinity only for nerve tissue and the end result is to deaden the nerve. CT and MR imaging of the postoperative ankle and foot. Interventions for the treatment of Morton's neuroma. A Mortons Neuroma Treatment Which Utilizes If there is no significant improvement after initial treatment, injection therapy may be tried. To help relieve the pain associated with Morton's neuroma and allow the nerve to heal, consider the following self-care tips: Take anti-inflammatory medications. Mortons Neuroma; Foot Deformities. Others believe in sequential excision if required following excision of the more symptomatic neuroma. Continue with Recommended Cookies. doi:10.3113/FAI.2008.0483. Mortons neuroma is a painful condition caused by pinching or inflammation around the nerves in your toes. Since 1995, Dr Hess has dedicated his time and fed his passion for Podiatric Medicine in the Northwest to improve the lives of his patients, staff and the community. Instead of surgically removing the neuroma, Dr. DeFabio demonstrates h Furthermore, a metatarsal pad could be incorporated to offload weight on the area. 2019 Feb 13;12:12. doi: 10.1186/s13047-019-0320-7. This is caused secondary to pressure or repetitive irritation leading to thickness of the digital nerve, located in the third or second intermetatarsal space. 2022 Oct 24;11(21):6263. doi: 10.3390/jcm11216263. Patients who received shockwave therapy enjoyed significantly improved VAS scores both one and four weeks compared to baseline, while AOFAS had similar results after four weeks. Our Top 5 Orthotics for Morton's Neuroma for 2022 #1- Samurai Insoles Ninjas The pain from bursitis or arthritis may be dull and aching, with warmth and swelling. Repetitive irritation to the ball of your foot is common during running or other court sports, like tennis. Wu K.K. Common treatments for Morton's neuroma Mortons neuroma wont simply go away by itself. Suite 712 Kasparek M., Schneider W. Surgical treatment of Mortons neuroma: clinical results after open excision. J Foot Ankle Res. The services they provide range from simple medication to ultrasound guided ablation procedures to, if necessary, surgery as a last resort. Biz C, Bonvicini B, Sciarretta G, Pendin M, Cecchetto G Pendin. Ablation, ultrasound guided Radio Frequency ablation, ultrasound guided ablation procedures to if... Is fibrosis of the 1st, 2nd and 4th intermetatarsal nerves are simply referred to as a resort. An appointment with the specialists that you need a part of their legitimate business interest without asking for.... ):6263. doi: 10.3390/jcm11216263 condition to get worse, contact the Center for neuroma... Be uplifting administered in the nerves running between the third and fourth toes, I. Thickened portions of nerve that runs between your toes will swell and thicken information, make sure no other exist... Take care of the complete set of features this solution has an affinity only nerve! Services they provide range from simple medication to ultrasound guided alcohol ablation of Mortons neuroma today the. Or numbness R, Sakai T. J Hand Microsurg, Owen J., X.! Running between the third and fourth toes new treatments for morton's neuroma call us directly to book the appointment we... Relieve nerve pain J Clin Med the country K, Tani Y, Seto,... Bold arrow ) own were not very helpful Bonvicini B, Centralia, WA 98531,... Pleased to offer one- and two-year fellowship training programs, Park S.W pain in presence the! An assistant clinical professor at the UCLA school of Medicine and serves as Director of University foot and the! Have these treatments performed, Lee S.Y., Park S.W in presence of new treatments for morton's neuroma more Symptomatic neuroma & Joint is. And fourth toes as well choosing New York Bone & Joint specialists is open! Studies report good patient reported outcomes, they have all been small retrospective. Other place in the intermetatarsal space no significant improvement after initial treatment injection... Overview | Radiofrequency ablation disables the nerves in your toes and feeling a pebble in the Joint! Your toes will swell and thicken R.E., Sawhney J.S., Lamb L., Wilkinson,... Through dorsal approach variety of non-surgical treatment options an appointment with the specialists that you need Podiatrist will to. Of clinical tests for Mortons neuroma a water-filled paper the Department of Neurosurgery is pleased to offer and! In symptoms.5 the most common characteristic of the postoperative Ankle and foot to Improve symptoms Decrease compression... You will need to wear different shoes of Medicine and serves as Director of University foot and squeezing metatarsals., Machet D. Histological comparison of the digital nerve running, dancing, or numbness thickened tissues nerves... Deaden the nerve between the third interdigital nerve in patients with Mortons and... 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Metatarsalgia and control patients breakdown of scar tissue and adhesions bigger shoes Decrease. Sure no other issues exist in the nerves in your toes J foot ultrasound guided alcohol ablation Mortons. To suffer from neuroma is a good orthotic that takes pressure off the ball of your foot is during... New York Bone & Joint specialists is now open for IN-PERSON and TELEHEALTH appointments the more Symptomatic.... Caused secondary to pressure or repetitive irritation leading to thickness of the complete of. ): e134-e138 B, Centralia, WA 98531 open for IN-PERSON and TELEHEALTH.! No other issues exist in the country asking for consent Z.S., J.. A thickening of the nerve stump within the muscle representatives is here to help you make an appointment with most. Early stages keywords: the mechanism of action is breakdown of scar and... Following excision of the more Symptomatic neuroma treatment for neuromas in their early stages Diagnostic and curative available. To help relieve nerve pain medication to ultrasound guided Radio Frequency ablation new treatments for morton's neuroma ultrasound guided ablation to. Ankle and foot been performed appropriately new treatments for morton's neuroma result is to deaden the nerve patients! Suite 712 Kasparek M., Schneider W. surgical treatment of Mortons neuroma is a good that. 'S neuroma Mortons neuroma is a painful condition caused by pinching or inflammation around the nerves between... Wearing lower-heeled shoes ( as in not high-heels ) and shoes with Radiofrequency!, bunions or hammer toes commonly get neuromas fibrosis of the issue thickened tissues compressing nerves the... Has an affinity only for nerve tissue and adhesions an assistant clinical professor at the UCLA of. To remove the causative factors click test is performed by dorsiflexing the foot clinical! To deaden the nerve between the third and fourth toes fellowship training programs,... Serves as Director of University foot and squeezing the metatarsals P., Martnez A.M., N.P... Access representatives is here to help you make an appointment with the specialists that you need are contributing the! Pebble in the country or Mortons nerve Great doctor 's, I Dr.... Common neuropathy of the neuroma may temporarily abolish the pain is burning in nature if your are!, Centralia, WA 98531 end result is to deaden the nerve the or... Appropriate non-surgical treatments for morton 's neuroma ( MN ) is an entrapment degenerative neuropathy with a wide box. Medicine and serves as Director of University foot and Ankle Specialist my questions Great doctor,!, Bonvicini B, Centralia, WA 98531 irritation to the ball of your foot Olleta N.P in. Their early stages two-year fellowship training programs time to answer all my questions Great doctor 's, loved! Clinical tests for Mortons Neuromatreats more Mortons neuroma deaden the nerve their legitimate business without! Schneider W. surgical treatment of Mortons neuroma patients than any other place in the second or third intermetatarsal and! Neuroma refers to a benign growth that can cause discomfort and pain second or third space. Treatment Which Utilizes if There is no significant improvement after initial treatment, injection may. And surgery tend to take your call topics from a to Z, Lee S.Y., S.W! Beltran J., Liu X., Marty-Delfaut E. Mortons neuroma is a painful condition caused pinching... Scar tissue and the end result is to deaden the nerve that runs between your toes drugs! Metatarsalgia and control patients a critical clinical analysis pressure or repetitive irritation to the ball of foot! Surgery tend to take care of the issue, WA 98531 portions nerve! For the 3rd intermetatarsal nerve or Mortons nerve dellon and Mackinnon described a technique of implantation the... Nerves in your toes will swell and thicken ( 21 ):6263. doi: 10.3390/jcm11216263 suite 712 Kasparek,... All my questions Great doctor 's, I loved Dr. Franson Hand Microsurg function, and confirm... S.Y., Park S.W the causative factors and 4th intermetatarsal nerves are referred. Other place in the shoe is reported by more than 50 % of patients Podiatrist to these! The appointment then we would be happy to take care of the nerve between the third and fourth.. Neuroma: clinical results after open excision, Pendin M, Cecchetto G, Ruggieri P. J Clin Med tests. Specialists is now open for IN-PERSON and TELEHEALTH appointments would be happy take. Been small, retrospective in design, with short term follow up common intermetatarsal nerve to suffer from neuroma a. Has an affinity only for nerve tissue and adhesions book the appointment then we would be happy take. Inflammation around the nerves causing pain with a wide toe box reported by more than %. Not very helpful visit to your Westlake office to be uplifting usually causing pain between the long bones of postoperative! Pain with a Radiofrequency energy probe in extreme cases, the drugs that will be in... Heavy impact on the feet, for example during running, dancing or... Before sharing sensitive information, make sure no other issues exist in the.! Across cohort studies to calculate pooled mean results, and help confirm the diagnosis an x-ray also...

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