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Hi there,
I had a patient come in today, 55yo female with a painful medial foot, basically only when she uses the clutch or foot parking brake in her car. Pain is sharp/shooting, and doesnt occur regularly. It usually resolves within minutes. The location of pain is along the dorsal 1st metatarsal, but was unable to be palpated. There was no pain on active/passive/resisted movement only some slight discomfort on DF. She is able to do as much walking/activity as she wants without reproducing the symptoms
Biomechanically, the foot was abducted compared to the left but other than that no abnormalities. Ankle DF was restricted.
I am suspecting medial plantar nerve entrapment, but am keen to hear others' thoughts. Is there much conservative treatment for this if it is a nerve entrapment? Will stretching/improving ROM help symptoms?
One option was to get an automatic car :p
Rory

 

Rory:

The medial plantar nerve supplies the plantar foot, not the dorsal 1st metatarsal. Both the deep peroneal and medial dorsal cutaneous nerves supply the dorsal 1st metatarsal.

 

Sorry, thinking about the case again, I'd meant to say that the pain was medial/plantar 1st Met, dont know why I put dorsal...
In terms of treatment/management what can be done if it is a nerve entrapment?
Regards
Rory

 

Rory,

I think you need to be solid about your diagnosis of nerve entrapment, medial plantar or otherwise before you embark upon a treatment plan.

Think what tests you can do to determine if your suspected diagnosis is correct. If they turn up to be negative, what are the structures that underlay the area of greatest pain. Build up your differential diagnosis and eliminate them.

Hope this helps(hint- Tinels sign/slump/SLR)