Joplins Neuroma

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Joplin’s Neuroma/Entrapment of Medial Plantar Digital Nerve

Neuroma of medial plantar proper digital nerve  supplies medial aspect of hallux. F>M.

Aetiology
Chronic compression and repetitive trauma to nerve  could be due to tight footwear (described as being more common in cowboy boots); underlying deformity (eg bunion); trauma; adhesion following HAV surgery. Abnormal neural tension from a pathomechanical problem may play a role.

Clinical features
Varies from dull ache and numbness to shooting pain over along medial aspect of first metatarsophalangeal joint and hallux – generally exacerbated by tight shoes. Sometimes get discomfort from bedclothes May have numbness and parathesia on dorsal, medial and plantar aspects of great toe. May be burning/cramping pains in arch. May be able to palpate ‘cord’ or ‘nodule’ over medial aspect  reproduce symptoms. Tuning fork  vibration loss. May get Tinnel’s sign. No motor symptoms.

Differential diagnosis:
Osteoarthritis, rheumatoid arthritis, gout, capsulitis, bursitis, sesamoiditis, trauma

Management
Ice to reduce inflammation  later may need NSAID’s; wider footwear or footwear modifications; accommodative padding; corticosteroid injection; surgical removal

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