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The response to the question below was authored by Marc Mitnick DPM
over sensitive toe after nerve block
by Robbie
(Lawton,Ok)
i had a jones fracture left foot May 11 2013 that was non-union and had a bone graft with plate put on Aug 30 2013. I used a bone stimulator and non WB with still a non-union so i had a second surgery removing plate and had a screw put in with stem cells Dec 13 2013 and a nerve block with ultrasound behind my knee because i woke up in severe pain. i was fully numb for two weeks!!! no complaint here! just the constant tingly feeling was annoying. However, its 3 weeks, i have a cast on and a hole cut out on the side for the new bone stimulator that requires skin contact and all feeling is back and in in no pain but my big toe is extremely sensitive to the touch. It hurts but feels good to touch. I massage it and it causes pain and makes me jerk cause its so sensitive but yet it feels good. its driving me insane! i know it sounds odd but i even use forks or a stick to rub the backside of my toe. its like massaging a sore muscle that hurts so good. i keep begging my boyfriend to massage it or scratch it and i make faces because it does hurt (too.sensitive) but it feels good and i cant help it. its very frustrating and curious if this has happened to anyone else? is it bad to massage when its sore after doing it? and does it have to do with my surgery n will it go away?
RESPONSE
Hi Robbie,
The first thing in your narrative that jumps out at me is the fact that after you had the nerve block at the level of your knee, you had no feeling for two weeks. Kinda long don't you think? Even with a long acting local anesthetic, we are
On that basis, it would seem to me that there may have been some damage done directly to the nerve from the needle. In most cases when we do an injection, the needle ends up near the nerve, but in some cases the needle may actually hit the nerve and do some minor damage.
If this is the case and the needle did hit the nerve then you have what is known as a neuritis (inflammation of nerve) and the part of the large nerve branch that goes to the big toe is being affected.
This is usually a self limiting problem and eventually will go away, but you might want to make your surgeon aware of the issue and let he or she decide if it requires any kind of treatment.
There is another possible explanation for the sensation that you are experiencing in your big toe and that might be that the cast you have on is too tight, particularly near the top of the cast as it approaches the knee.
Sometimes if the cast if too tight against the bony part of your leg just below the knee that too will put pressure on the nerve and cause your symptoms. Additionally, sometimes if the cast is too tight around the ankle area that will create similar issues.
Check to make sure you can get your index finger into the cast at the top, if you are having a problem doing that, then that too should be brought to the attention of your doctor because if it stays tight too long it can do permanent nerve damage.
In general any unexplained pain or abnormal sensation should be brought to the attention of your doctor.
Marc Mitnick DPM
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ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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