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Joplins Neuroma?????

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Aug 1, 2014.

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    Just seen this other-wise fit and healthy 16 year old male who presented with numbness in his hallux of two weeks duration. The boy is a good standard rugby fly-half (lots of pivoting movement). He presented wearing flip-flops. The area of anaesthesia is mapped in the attached image, there is no parathesia, burning or other symptoms, the area is simply numb. I palpated for a Joplin's neuroma but could not feel anything, nor induce a change in symptoms in doing so. No family history of neuropathy.

    Your thoughts please...

    Attached Files:

  2. Simon

    Have you looked at his boots yet? If they are tight-fitting it may be nothing more that a transient neuropathy caused by trauma or pressure to the medial plantar nerve. I usually develop the same problem wearing rock-climbing shoes - which are notoriously tight fitting. Both hallux. Same area. This usually clears after 2/3 weeks in normal footwear/sandals.

  3. He presented in flip-flops, without his boots.
  4. Ok simon, I'm replying to you halfway up a climb on Scafell presently - please excuse the oversight. Next time you see him...
  5. Lab Guy

    Lab Guy Well-Known Member

    Simon, my guess is that the pivoting motion playing Rugby has caused desensitization of his cutaneous nerve endings of his hallux. I don't think its anything to be concerned about now or in the future. Joplins is in the differential but very unlikely at his age and objective findings IMO.

  6. Griff

    Griff Moderator

    Had a similar presentation recently in a fit healthy chap who played 7 rounds of golf in 7 days. Right hallux and right handed golfer. My working hypothesis was/is a transient compression of his dorsomedial cutaneous nerve. His area of numbness extended a wee bit more proximal than your region - up to about about the IPJ.
  7. see that little area of contusion proximal to the ipj....ditto Steven & Ian's suggestion.
  8. I would consider this to be a transient compression neuropathy caused most likely by tight fitting rugby boots, as others have suggested. In a Joplin's neuritis/neuroma, there will be a positive Tinel's sign with "rolling" of the medial-plantar hallux nerve and also the numbness/burning/parasthesias will be a larger area nearly always encompassing the medial-plantar skin of the hallux from the interphalangeal joint distally. In transient compression neuropathies, such as this likely is, removal of shoe pressure to the area will likely allow return of normal sensation to the affected patch of skin within 2-6 months. Good case!

    Hope this helps.:drinks
  9. NewsBot

    NewsBot The Admin that posts the news.

    The Diagnosis and Treatment of Joplin's Neuroma
    Mark M. Melendez, MD, MBA, Anup Patel, MD, MBA, A. Lee Dellon, MD, PhD
    The Journal of Foot and Ankle Surgery; Articles in Press

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