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Saturday, October 12, 2013

Nerve Pain Around Big Toe Joint: Email Advice

Doc,

I have nerve pain that presents around the 1st MTJ pad, but is centered between the 1st and 2nd MTJ pad has stopped me running and severely effects my ability to walk normally. 
Dr Blake's comment: This is either a local problem with the deep peroneal nerve, or an L4/L5 Disc Issue. 



 My GP took an xray to rule out fracture.  He thinks it is a neuroma and has referred me to a podiatrist, but I won't be able to get in for another month.  As you know that's a long time for a runner, and I hate to be doing anything that would make it worse for a month.  So my question is, is contrast bathing good for nerve pain? 
Dr Blake's comment: Patients with nerve pain love contrast bathing in general since it soothes the nerve by removing inflammation from around the nerve. 



 That seems like something fairly benign that I could start doing right away.  In my desperation, I also grapped some Dr. Scholls metatarsal pads and am experimenting to see if I can find the right spot for placement to see if it addresses the pain.
Dr Blake's comment: Go to www.mooremedical.com and order a roll of 1/8th adhesive felt. You will have more flexibility in where you put padding. Be creative!!!

https://www.mooremedical.com/Index.cfm?Ntk=all&No=0&Search=Search&Ns=Searchorder%7C0%7C&Ntx=mode+matchpartialmax&Ntt=adhesive+felt&x=33&y=9

Which leads me to my deeper question. I have heard a podiatrist say that a neuroma is a symptom of some underlying issue that caused the nerve to fire off in the first place, and that the underlying cause should be found and addressed in addition to treating the actual neuroma.  Is that the way you approach it?
Dr Blake's comment: Nerves fire bad for many reasons. It can be the nerve itself locally, it can be just a symptom that the nerve is stressed somewhere above (double crush syndrome), and it can be from an outside irritant from poor mechanics, bone spur, swelling in the area from a broken bone, etc. You have to treat the nerve, but not have tunnel vision and also look for other reasons the nerve is unhappy. 

Thanks for this blog! It has been very informative.
Regards,
Michael (name changed)

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.