Shooting pain under 2nd toe

by Kim G
(Foley, Mo)

I have pain under my 2nd toe on the ball of my foot. Went to dr & she diagnosised me w/ a torn planter plate. I have been wearing orthotics, a pad, no jogging/working out, no steps, no high heels and stiff soled shoes for 6 mos w/ no relief. She finally did a MRI & it did not show a thing. So I went to get a second opinion & he says its a neuroma between my 2nd 3rd toes and I need surgery (since I've been babying it & it's not helping). So now I have 2 different diagnosises. My pain consist of pain directly under my 2nd toe (I can't even press on it, like on the ball of my foot where the joint is). The pain shoots up my toe between that toe & my big toe. It will also just throb. Then it will hurt over under my 4th toe. Any suggestions????

RESPONSE

Hi Kim,

This is a tough one to diagnose from the other side of the internet. It would be nice if I could actually examine your foot. The problem is that neuroma and capsulitis (inflammation of the plantar plate without a tear) are the two most common causes of pain in the area where you are having pain.
At least you have had an MRI which shows no tear. I do not know how the first podiatrist could have made that diagnosis without an MRI.
I will say this, in general if your pain is directly underneath the second toe, not to one side or the other, than I would lean more towards capsulitis than neuroma.
Secondly, it is important to point out that capsulitis can in many instances give neuroma like pain (shooting pain into toes, tingling, burning, etc.), as the inflammation and swelling from capsulitis will put pressure on the otherwise normal nerve and mimic the symptoms of a neuroma.
I understand the second podiatrists opinion that since you have been in sensible shoes and wearing orthotics for a period of time. in his way of thinking, the problem is not going away, so lets operate.
I would take a different approach simply because I am not convinced that it is truly a neuroma. What if you have the surgery and he removes the nerve and you still have pain, than what?
So, before I would consent to any surgery I would give some thought to injection therapy. This would occur in one of two forms.
The first would be a series of cortisone injections which hopefully reduce the inflammation occurring in your forefoot. A cortisone injection is helpful for both capsulitis and neuroma so an accurate diagnosis is not always necessary.
If you feel comfortable with the second podiatrist in his assessment of a neuroma, why not ask him for denatured alcohol injections, or other less invasive procedures such as radiofrequency ablation, which is an insertion of a probe which deadens the nerve through radiofrequency waves, or perhaps even cryosurgery where a probe in inserted through a small incision and the nerve is "frozen" in an effort to stop the pain. So, if it turns out he is wrong in his diagnosis, you at least have not subjected yourself to surgery with all the associated drawbacks. There is countless documentation out in the medical literature about patients who have undergone "interspaceectomies" meaning the surgeon removes everything in the area of pain, but afterwards the patient still has pain because in reality there never was a neuroma.
That would be the approach I would take when a diagnosis of this sort is not definitive. If neither of these podiatrists offer any of the choices I suggested you might consider seeking the evaluation of a third podiatrist and see if he or she agrees with either of the previous two podiatrists.

see related article....capsulitis

see related article....Morton's neuroma



Marc Mitnick DPM
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