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Hi all

Anyone throw some light on this problem I had today:

Patient - lady 42 no significant med hist or meds.

Had NV corn plantar 4th MPJ left - many years - extremely tender to light pressure. Today intended to remove under LA tibial block - mepivicaine 3% plain. administered 2.2ml which gave full analgesia to plantar foot, except for a very small area just distal and medial to the lesion. So I administered another 2.2ml but no change - however she reported sharp pain even when using light touch with blunt probe.

She was a bit needle phobic and giving injections caused her distress but not significant pain. However I decided not to infiltrate the plantar surface with LA for this reason.

I was able to debride most of the NV corn without pain but a small area of the distal lesion was extremely tender with only light touch with the blade and debriding normal hyperkeratotic skin just beside it was also giving a sharp/burning pain sensation.

Is it possible she developed discreet mechanical allodynia> is it possible to have allodynia (or hyperalgesia) when the innervating nerve is blocked or do you think that there may have been a stray fibre penetrating from the dorsal nerves??

Regards Dave Smith

 

As a follow up - after 1 week with 70% salycilic acid dressing the NV corn is pain free and could be fully debrided without pain.