abnormal toe ache

Members do not see these Ads. Sign Up.

Hi everyone,

I was hoping to find the answer to a very simple problem I cannot solve:wacko:

I have a patient who I visit regularly for nails/corns/callous, who is suddlenly c/o a strong pain (aching) in apex of her RD1. The pain is so intense it is waking her up in her sleep.

She has OG BD1, and also cal apex of RD1, approx 5-10mm distal to the nail tip where she is c/o pain.

The cal from what I can see is not formed due to her shoes or abnormal wear patterns etc, I cannot find an obvious reason for her callous formation. Reducing OG nail has no effect on the pain. The toe itself is not red and looks 'normal' and I couldnt think of a reason as to why suddenly the pain would be occuring and why the callous would be there?

Hx of laminectomy ~10 years and back pain 37years. She is on methodone and morphine treatment for the pain in her back. She is unsure of the details of her back operation, however I was wondering if this would be some how related.

BD2-5 clawed toes and BPMA atrophy. She is wearing low density formies and slow release poron as PMA padding in lace up homy peds outdoors and slippers around home. Both shoes fit well

I was hoping someone had a simple answer to the callous formation and pain??


Thankyou

 

Aussie best if you spell out the abbreviations you have used

BD1
OG
RD1
C/O
BD 2-5
BPMA
Rather than guessing what you mean then maybe you might get some better help

 

Sorry! Assumed you all know my short hand!!!

BD1= Both Digit 1

OG= onychogryphosis

RD1= right digit 1
C/O = complains of
BD 2-5= both digits 2-5
BPMA = both plantar metatarsal areas

Thank you

 

No worries

The callous formation must becoming from some friction based stress, my guess she is dorsiflexing her toes during gait or sliding forward into the front of the shoe when walking and the toe is coming into contact with her shoes. Check out and old pair of shoes to see if she has worn the upper over the top of the apex of the 1st and get he to stand on a slope to see if she slides forward in her shoes.

Does the pain reduce when you debride the callous ? Have you tried to pad the area to see if symptoms reduce ?

The callous might be the cause of the pain may not. But I guess if the callous came same time as the pain began good place to start working from.

Hope that helps some

 

Hi Michael,
Thanks for replying. I was assuing she dorsiflexed against her shoes too and was considering padding them. I was just second guessing myself as to the cause. I will just continue to debride the callous again and make up some padding and cross our fingers it is as simple as that.
It's normally the easiest answer that trips me up!

Thanks again

 

The Aussie

Is there any paraesthesia or tinels sign? Pain that wakes at night is often associated with nerve trauma, however I have found almost 100% of the time when someone complains of a toe pain that wakes then at night, especially the hallux and especially if they say it hurts with the sheets resting on it, then it will be a sub ungual corn. You have reported a thick nail and callus on the toe so there is excessive pressure and friction, which might also have caused a corn under the toe nail.

Regards Dave

 

Pure guesswork, have you ruled out a sub-ungual exostosis? They aren't always clinically obvious.

Bill Liggins

 

No paresthesia, but I hadn't checked Tinels sign, could be interesting as she is very hypersensitive.
Hadn't ruled out either of these, thank you. The subungual corn should be easy to find if present, she has onychauxic nails that I am treating. If I find these methods aren't working, I will investigate an exotosis!