Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
I have a young female patient complaining of numbness to the entire great toe from the base to the tip, dorsal and plantar. It's constant and painful as well as numb. This is obviously a nerve problem but my question is how to distinguish which nerve since it's crossing multiple different nerve paths? I've tried local anesthetic to different nerves at different visits and none of the diagnostic injections have gotten rid of the pain. Any help is appreciated.
I've found the most common causes of hallux nerve pain / paresthesia to be medial dorsal cutaneous nerve compression or deep peroneal nerve entrapment. Or obviously neuropathy.
However your post is slightly confusing. You say you've performed diagnostic anaesthesia to no avail (i presume tibial, s.peroneal and d.peroneal). Is this not impossible, at some point blocking innervation to the hallux would provide symptomatic relief? Sorry to question your technique, but are you performing the injections correctly?
When blocking the toe I've blocked one nerve at a time, on different visits, to see if one would significantly decrease her pain. She's noticed that with each block she notices numbness but no decrease of the pain. She's had EMG/NCV's which show no abnormality. As of today her pain is progressing proximally. No skin changes, no temperature changes, no swelling. Vascular status is normal and Capillary refill time is normal. No injury. Pain has been on going, constant for a few months. She's guarding and extremely tender with even the slightist palpation.
When blocking the toe I've blocked one nerve at a time, on different visits, to see if one would significantly decrease her pain. She's noticed that with each block she notices numbness but no decrease of the pain. She's had EMG/NCV's which show no abnormality. As of today her pain is progressing proximally. No skin changes, no temperature changes, no swelling. Vascular status is normal and Capillary refill time is normal. No injury. Pain has been on going, constant for a few months. She's guarding and extremely tender with even the slightist palpation.
Due to the allodynia, you must consider this patient has chronic regional pain syndrome (CRPS). I suggest a referral to a podiatrist who sees lots of these patients or to a pain management specialist for consultation.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
numb great toe
Linear Mode
