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The response to the question below was authored by Marc Mitnick DPM

Foot pain from broken tibia

I have chronic swelling and pain at the base of the second and third toe. Increases when walking or going barefoot. I have had an MRI done which ruled out Morton's Neuroma. I had trauma to that area about 20 years ago. About 6-7 years ago, that area as well as the effected toes felt like they were on fire and pain would wake me up at night. Ice cold water or ice seemed to alleviate the discomfort. Acupunture treatments seem to clear up the condition. About 2 years ago the pain and swelling came back. Acupuncture has not helped. Have tried to look up symptoms online but have not been able to find anything that resembles the symptoms. Any idea what this could be and how to take the swelling and pain away?

RESPONSE
Hi,
I should out by stating that over the years I have had patients who had MRI's that did not show a neuroma, only to go in surgically and remove a neuroma. In other words, I do not find an MRI to be a great test for Morton's neuroma. I use it more to rule out other problems like an intermetatarsal bursitis or even a plantar plate tear. (I would assume if you had either of those conditions or any other abnormality in that area, the MRI would have pointed it out)
So I would not rule out neuroma completely. If I were treating you I would go by your clinical symptoms, particularly if

there is any change in sensation at the end of either the second or third toe. You mentioned several years ago you had a tremendous pain in the toes feeling like they were on fire. That to me sounds like neuroma more than anything else.
A neuroma is one of those things that can flare up from time to time, because in general once the nerve is thickened it can begin to hurt again out of nowhere. Wearing a shoe that is too narrow or has a high heel or a thin sole can all exacerbate the symptoms.
Many times neuromas, much like other medical conditions, can worsen over time, so what once worked to relieve the pain, may no longer be satisfactory.
Have you had any other treatments beside acupuncture or the application of ice? If you were sitting in my treatment room I would be inclined to think neuroma first and treat it accordingly. Treatments like oral anti-inflammatory medication, cortisone injections, physical therapy, and certain types of padding in the shoe can all reduce the pain of neuroma. The better news is that these same treatments may go a long way in reducing your pain, even if you do not actually have a neuroma, but it turns out to be one of the other conditions I previously mentioned.
If you are concerned and confused about what might be going on, I would suggest you seek a second opinion from a doctor in your area.

Marc Mitnick DPM
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Foot pain from broken tibia

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