Joplin’s Neuroma/Entrapment of Medial Plantar Digital Nerve
Neuroma of medial plantar proper digital nerve supplies medial aspect of hallux. F>M.
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.
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.
Osteoarthritis, rheumatoid arthritis, gout, capsulitis, bursitis, sesamoiditis, trauma
Ice to reduce inflammation later may need NSAID’s; wider footwear or footwear modifications; accommodative padding; corticosteroid injection; surgical removal