A Joplin’s Neuroma or neuritis is an entrapment or pinching of what is known as the medial plantar digital nerve. This nerve gives sensation on the medial side and parts of the top and underside on the great toe. This specific pinched nerve was first identified b y Joplin in 1971 in three cases which developed following bunion surgical treatment. The reason for a Joplin’s Neuroma is most commonly due to a chronic pressure about the big toe or hallux with recurring injury to the medial nerve. This is mainly likely to take place if wearing tight fitting shoes, especially if there is an underlying problem such as a bunion of the great toe or hallux. It can also happen in some cases after a solitary occurrence of trauma as opposed to the repetitive injury from shoes. Additional instances are caused by an adhesion of the nerve in scar tissue following bunion surgery.
The common features of a Joplins neuroma can vary from dull ache discomfort and a bit of numbness to an acute shooting or radiating pain that comes about around along the side of the big toe. The symptoms can usually be made more serious by the ongoing wearing of tight footwear. There may also be some pins and needles or tingling around the region. If you very carefully palpate the region of the nerve, it is from time to time possible to feel a mass over the location and the pressing on this lump can cause the signs and symptoms which the individual is experiencing. There are a number different disorders that could mimic these types of signs or symptoms because the signs and symptoms of a Joplin’s neuroma can be somewhat vague. It is important to get the medical diagnosis right before proceeding with treatment. The differential diagnosis includes just about any other disorders which has an effect on the big toe joint. This may consist of osteo arthritis, rheumatoid arthritis or gout pain. The signs and symptoms of these tend to occur more inside the joint as opposed to radiating pains around the joint. There could be inflammation from a bunion with a bit of bursitis that will not involve the nerve getting trapped. A sesamoiditis may also be considered, however, this is painful underneath the big toe joint and does not shoot forwards. There also might be a traumatic injury to the big toe joint or the tissues around the joint.
The first aspect of the treatment of a Joplins neuroma is to get some alleviation in the pain if it's bad enough. This could include using ice as well as medications to alleviate the symptoms. The most significant aspect of the treatment is using wider fitting shoes or to modify the footwear to allow less pressure on the big toe or hallux joint. This is often complicated if tight fitting shoes needs to be used in sports such as football. Felt accommodative pads to get stress off the affected area could be very helpful. This felt padding can be in the shape of a ‘U’ or perhaps a donut. This really is necessary so that there isn't any force on the area the symptoms are coming from. An injection of corticosteroid is sometimes required to settle the issue. If none of this helps, then a surgical removal of the affected nerve may be needed.