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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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Mayo Clinic

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Drugs.com

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Penn State Medical Center

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Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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Poland

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location unknown

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anonymous

Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

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Seattle, WA

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New Jersey

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Evansville, IA

Dear Marc

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San Diego, CA

Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

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Albany, NY

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Whichita, KS

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Boston, MA

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Colorado

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Colorado

Wonderful advice

by: Anonymous

This is the best site for foot problem info.

Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

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location unknown

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Canada

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Wisconsin

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location unknown

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North Carolina

Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown

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Bessie Mae

Florida

Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

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New Jersey

Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

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Lenoir, NC

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Bellevue, WA

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Jodi

location unknown

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