numbness in arch area, feels like walking on sock underneath metatarsal bones

by Joan
(Plover, WI, USA)

Hi Dr. Mark, I have a questions about the sensation in my left foot that has troubled me for quite awhile. Years ago (at least 25) I had a morton' s neuroma removed which left me with just a small area of numbness in the ball of this foot. I also have high arches. Feet were fine until about a year and a half ago when foot pain developed in my left ball of foot again. Saw a podiatrist who said it was capsulitis, but offered no treatment. Next foot Dr. took X-ray and saw no abnormalities and referred me to neurologist who did emg test and ordered cat scans of cervical and lumbar spine. Some numbness present. I have a bulging disk somewhere near S1-L5 and stenosis, osteoarthritis and compressed L-4 nerve root. Sent to physical therapist who did some back and foot work and inserts for shoes. Exercises to do at home. Numbness was not as prominent then. Gabapentin was tried and Cymbalta but made me too tired with other medications. Also got orthotics from another podiatrist that hurt the arch. The pain has subsided but now I have such numbness under my metatarsal bones and in arch-feels like a sock in the arch. Have tried acupuncture, another set of orthotics that still hurt the arch. I am wondering if I have a medial plantar nerve compression. The big toe metatarsal joint also can be painful but I have no fat pad left there apparently. I am wondering what I can do about this. I keep massaging, using lidocaine patches, Volteran, icing, and nothing seems to change. What would be most helpful for me? Could this be coming from my back. I have some back pain in the morning but it subsides and no leg pain. I

have spend a lot of money trying to find out what works to no avail.

Thank you for any suggestions.
Joan

RESPONSE

Hi Joan,

This is a situation where I would actually have to examine you because I am not getting a clear picture of where your numbness is occurring.

Having said that there are a couple of things to consider.

The first thing that comes to mind is what is known as a stump neuroma. Years ago you had a neuroma removed. Well, nerve does regenerate over time and there is a strong possibility that the numbness you are experiencing is coming from the partial regrowth of nerve, particularly since one podiatrist called it capsulitis, while that was not the correct diagnosis, it does occur in the same area of the foot.

Capsulitis will not extend further back into the arch but a defect in the nerve certainly could.

With a history of neuroma surgery, that would have been the first thing I would have thought of.

This would not be an issue of the medial plantar nerve, but the lateral plantar nerve could be in play here as that is where the intermetatarsal nerve arises that is Morton's neuroma.

The other possibility could be from your lower back since there is a history of stenosis in the area of lumbar-sacral region.

But again I would still be leaning more towards regeneration of the intermetatarsal nerve as the source of your problem.

Why not try one cortisone injection in the area and see if that results in any improvement, even if temporary, would indicate the problem is coming from the local nerve and at least you could then have more aggressive treatment, such as denatured alcohol injections in an effort to reduce your symptoms.

Marc Mitnick DPM
DISCLAIMER

Numbness and some pain in arch

by Joan
(Plover, WI USA)

Thank you for your prompt answer. I appreciate your advice so much. My neuroma surgery was between my third and fourth toes and the slight numbness of years ago was on the ball of foot near those toes. This numbness and some pain I have now is on the outer arch and under the big toe. This is where the feeling of a sock is. Sometimes accompanied by pain.I notice today there is some swelling on top of my foot below my second toe. This has happened before. Then with ice it subsides. I do ice my foot at night. I have seen a pain management Dr. who read my records and thinks this problem is coming from by back. He suggested an epidural shot in my back at the place of compressed nerve. I haven't made another appointment yet because a New Year started and I have a large deductible and the first visit was very expensive. I will be on Medicare next month so I am waiting till then to decide if I want to go that route. This problem has made my life a little more complicated as I can't do what I always want to do. I have read where cortisone shots in the foot sometimes weaker the area. Plantar fasciitis was also mentioned as a possibility but I have no heel pain or sesamoiditis. These were mentioned by one of the podiatrists. I know you are a very busy man and I am grateful for the possibilities you have given me. Thank you. Joan