A Joplin’s Neuroma or neuritis is an entrapment of the medial plantar digital nerve that innervates the medial aspect of the big toe. It was first described by Joplin in 1971.
Cause of a Joplin’s Neuroma
A Joplin’s neuroma is most likely due to a chronic compression and repetitive trauma to the nerve, mostly due to pressure from tight footwear or an underlying deformity such as a bunion. In some cases there may be a history of trauma or an adhesion may develop following bunion surgery.
Symptoms of a Joplins Neuroma
The symptoms of a Joplin’s neuroma can vary from dull ache and numbness to shooting or radiating pain over along medial aspect of the big toe. Those symptoms can generally exacerbated by tight shoes. There may be numbness and tingling on the top and sides of the big toe and a tuning fork may detect a loss of vibration sensations. Sometimes it is possible to palpate a ‘cord’ or ‘nodule’ over medial aspect and reproduce the symptoms with that palpation.
Differential diagnosis includes: other first metatarsophalangeal joint pathologies, osteoarthritis, rheumatoid arthritis, gout, bunions, bursitis, sesamoiditis, trauma
Treatment of a Joplin’s Neuroma
The treatment of a Joplins neuroma could involve the initial use of ice and NSAID’s to relieve the symptoms.
Most importantly, wider footwear is important or footwear modifications to allow for less pressure on the big toe joint.
Accommodative padding from adhesive felt to get pressure off the affected area may be useful. This padding could be shaped like a ‘U’ or a donut, so that there is no pressure on the area the symptoms are coming from.
Sometimes, an ultrasound guided corticosteroid injection is needed and there may be a need for a surgical removal of the affected nerve.
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