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Friday, August 14, 2020

Foot Nerve Pain: Email Advice

Good afternoon,

I recently read a blog of yours pertaining to a sesamoid injury. Her questions and your answers were exactly what I am going through. It brought me to tears to finally read someone discussing my EXACT symptoms that I have been dealing with for 4.5 months. I have a few questions and some information of what I have done/currently doing.

1. I stepped on glass back in March. A small shard of glass entered my toe and came out perfectly in contact within a couple of hours. I hit a nerve in my toe apparently (or so I think) as I had immediate pain in my toe that was not in the area that the glass had entered. Due to Covid it took a while for me to get in to a doctor. For 2.5 weeks I taped my toe and walked on the ball of my foot or outside of my foot and lifted my big toe constantly. All of this was done by walking barefoot on my hardwood floors. 

2. I continued to have a change in gait for many weeks to come and continued to walk on the hardwood floors putting additional pressure on my ball of foot by lifting my toe. 

3. I have seen a total of 6 doctors, I go to PT 2x per week for ultrasound and ASTYM and strengthening, and I also do virtual meetings with Caroline Jordan out in California. I have had a few xrays done as well as an MRI. The MRI only showed some inflammation directly above the sesamoid bones.
Dr. Blake's comment: For my reader's sake, Caroline Jordan worked with another great podiatrist, Dr. Arlene Hoffman, also in San Francisco, and chronicled her healing and exercise program for a sesamoid injury. Here is a link to one of the YouTube videos.
4. I had lots of nerve pain initially with my injury. So much so that I wanted to always keep my foot elevated to help with the inflammation and keep any additional pressure off my nerves. I could barely walk into the other room or have a sheet touch my foot:

5. I now wear a Hoka bondi outside and Fresh Foam More shoes indoors. I only go barefoot in the shower. I have nerve like pain only in my sesamoid area (poking, pinching, burning) and into my big toe sometimes as well but less often then months prior. I do get a small bubble in the webbed area between my first and second toe as well as in my second joint in my big toe. My foot is sensitive to the temperate changes in the shower. I really don’t look forward to showering for this reason. I’m using ice about 10 mins a day. I take turmeric, liquid fish oil, and vitamin D supplement (after reading your blog).  I will soon be getting custom orthotics made. 

What exercises or stretches should I be doing?
Dr. Blake's comment: The treatment should be nerve focused. Nerve love motion, ice 5 minutes only, and warm compresses more. Nerves therefore love neural flossing or simple range of motion of the toe and ankle, but no prolonged stretches. Nerves do not like pressure, so make sure that the orthotics off weight the area. Nerves love massage, if it is non painful, so use Neuro Eze or Neuro One to massage 3-4 times a day. Both over the counter products. 

Is nerve pain normal with sesamoiditis?
Dr. Blake's comment: The nerves are superhighways to your brain, that is why they unconsciously force us into mega protection mode. You injured the nerve twice that runs from your toe to your sesamoid (same nerve I suspect). First, you traumatized with glass, and secondly, you traumatized it by either holding your big toe in the air, or walking on the nerve under the sesamoid. Luckily you should have been walking slow enough not to injure the sesamoid badly (alittle maybe??)

Are there any sandals that are okay to wear for short periods of time?
Dr. Blake's comment: Oofos sandals would be my best bet now due to the softness. 

I know healing time periods vary, but does there seem to be an average amount of time?
Dr. Blake's comment: The mantra I use is "Look at a nerve funny, and it hurts for nine months". You are 5 months along, and you are improving. The reason you wrote (I read between lines sometimes) is that you do not want to have a setback and start over again. 

What can I do for the nerve pain in the mean time as I heal?
Dr. Blake's comment: Start with the above, and when they are all in place, you can add other nerve treatments if your symptoms warrant: flossing, massage with topical, warm or ice, off weight with orthotics or gel pads, soft sandals, and no prolonged pressure or stretching. Keep me in the loop, and I will try to answer. Rich 

Thank you so very much for posting! This has been one of the most emotional times in my life and have felt quite alone until coming across blogs posted by kind people such as yourself. 

Kind regards

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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.