Pain in toe at site of previous injury

[A.B.]

I stubbed my right small toe years ago. Two years after that, it suddenly start to hurt again. It felt like some nerve was squeezed or the second joint (the one closer to the foot) was in an odd position. Doctors have not been able to diagnose this (I think they saw my CFS diagnosis and file and decided to figuratively run away). Maybe someone here has an idea?

There is a little bit of swelling in the general area but it's barely visible.

The second joint seems to have a slightly larger and harder hump compared to what is found on the corresponding left toe.

I cannot move the toe as easily as the corresponding left toe.

There is some constant background pain and discomfort. The pain gets worse with use of the toe, and in cold temperature. It also tends to get worse during worsening of CFS symptoms, but use and low temperature are the major reasons it hurts. The pain only goes away slowly once it's there.

The type of pain is dull and hard to pinpoint exactly. There can be tingling. Mostly it's discomfort resembling the one gets by pressing hard into the nerve in elbow, but worse.

I've had xray and MRI done. Xray showed nothing abnormal. MRI neither but I wasn't able to suppress involuntary movements of the toe due to the cold temperature in the MRI chamber.

A cortisone + lidocaine injection did nothing at all.

I had no other tests done. I've only seen a foot doctor, who assured me this was nothing like she had ever seen. My gp thinks nothing can be done and that I need to live with it (he probably thinks I'm exaggerating or somatizing or whatever).

How do I get this diagnosed and treated?

 

[Jonathan Edwards]

I stubbed my right small toe years ago. Two years after that, it suddenly start to hurt again. It felt like some nerve was squeezed or the second joint (the one closer to the foot) was in an odd position. Doctors have not been able to diagnose this (I think they saw my CFS diagnosis and file and decided to figuratively run away). Maybe someone here has an idea?

There is a little bit of swelling in the general area but it's barely visible.

The second joint seems to have a slightly larger and harder hump compared to what is found on the corresponding left toe.

I cannot move the toe as easily as the corresponding left toe.

There is some constant background pain and discomfort. The pain gets worse with use of the toe, and in cold temperature. It also tends to get worse during worsening of CFS symptoms, but use and low temperature are the major reasons it hurts. The pain only goes away slowly once it's there.

The type of pain is dull and hard to pinpoint exactly. There can be tingling. Mostly it's discomfort resembling the one gets by pressing hard into the nerve in elbow, but worse.

I've had xray and MRI done. Xray showed nothing abnormal. MRI neither but I wasn't able to suppress involuntary movements of the toe due to the cold temperature in the MRI chamber.

A cortisone + lidocaine injection did nothing at all.

I had no other tests done. I've only seen a foot doctor, who assured me this was nothing like she had ever seen. My gp thinks nothing can be done and that I need to live with it (he probably thinks I'm exaggerating or somatizing or whatever).

How do I get this diagnosed and treated?

Dear A.B.,
From what you say there isn't an awful lot more that can be investigated. The little toe is pretty much three tiny bones joined with cartilage and ligament in side skin. With nothing to get in the way any major structural change should be evident from physical exam or x-ray. Having said that, what often happens with small digit joints is that trauma is followed by a woody thickening around the edge of the joint that may turn to bone in time but at first just shows as a slight ridge around the joint. The cartilage surface of the joint may also wear without that being easy to see, although it should show on high resolution MRI.

If this a bone and joint problem then I fear it is likely to be a minor wear and tear issue that nobody is going to be able to fix much - unless you opt to have the toe removed of course (actually quite a reasonable option for some sorts of arthritis with a little toe).

The fact that this seems like a pressed nerve, with tingling, does suggest another possibility, which may be a spin off from a joint thickening. The toe has two nerves - one running up either side. These can get pinched. The commonest ones to get affected are in the gaps between first second and third toes but the little toe is at risk from side pressure. One thing that may be worth considering is spending a month or so never wearing shoes or socks that compress across the forefoot. (Is the tingling on the inner or outer side of the toe?) You might possibly get some good advice from a good podiatrist - you might benefit from a silicone insert. (I am not sure what a foot doctor is - I have never met someone calling themselves that in the UK although once I was asked to be a Professor of Foot Medicine, but declined!)

I apologise for giving medical advice here but I think this is a simple enough problem not to risk causing any great harm!

 

[lansbergen]

It also tends to get worse during worsening of CFS symptoms, but use and low temperature are the major reasons it hurts. The pain only goes away slowly once it's there.

I several times got old injuries hurt during flares.

@Jonathan Edwards. Any thoughts about that?

 

[Jonathan Edwards]

I several times got old injuries hurt during flares.

@Jonathan Edwards. Any thoughts about that?

Old injuries often hurt when inflammation is around for other reasons, like viruses. Back pain and joint pain often flare during a cold for instance.

 

[A.B.]

@Jonathan Edwards

How can I find out what the problem actually is? High resolution MRI with some means to avoid temperature related problems?

Is the tingling on the inner or outer side of the toe?

The inner side. It's hard to pinpoint exactly though. Mostly at the second joint.

One thing that may be worth considering is spending a month or so never wearing shoes or socks that compress across the forefoot.

Pressure or manipulation upsets the toe and then it starts to hurt and stays like that for hours, or a day. Best to leave it alone as much as possible. Unfortunately walking is a stressor.

 

[Jonathan Edwards]

@Jonathan Edwards

How can I find out what the problem actually is? High resolution MRI with some means to avoid temperature related problems?

An intelligent podiatrist might be able to make the right diagnosis by physical examination. I might have done twenty years ago.