What is a Joplin's Neuroma?

A Joplin’s Neuroma or neuritis is an entrapment or pinching of what is called the medial plantar digital nerve. This never provides sensation to the medial side and parts of the top and bottom of the big toe. This particular pinched nerve was first described by Joplin in 1971 in three cases that occurred following bunion surgery. The cause of a Joplin’s Neuroma is most commonly due to a chronic compression of the big toe with repetitive trauma to the nerve. This is mostly likely to occur when using tight fitting shoes, especially if there is an underlying deformity such as a bunion of the big toe. It can also occur in some cases following a single incident of trauma rather than the repeated trauma from shoes. Other cases are due to an adhesion of the nerve in scar tissue following bunion surgery.

The typical symptoms of a Joplin’s neuroma can vary from dull ache pain and some numbness to an acute shooting or radiating pain that occurs over along the side of the big toe. Those symptoms can almost always be made worse by the continued wearing to tight shoes. There may also be some numbness and tingling around the area. If you carefully palpate the area of the nerve, it is sometime possible to feel a lump over the area and the pushing on this lump can cause the symptoms that the person is experiencing. There are a number of different conditions that can mimic these symptoms as the symptoms of a Joplin’s neuroma can be somewhat vague. It is important to get the diagnosis right before proceeding with treatment. The differential diagnosis includes just about any other conditions that affects the big toe joint. This can include osteoarthritis, rheumatoid arthritis or gout. The symptoms of these tend to occur more inside the joint rather than shooting pains around the joint. There could be swelling from a bunion with some bursitis that does not involve the nerve being pinched. A sesamoiditis could also be considered, but this causes pain under the big toe joint and does not radiate forward. There also could be a traumatic injury to the joint or the structures around the joint.

The first part of the treatment of a Joplin’s neuroma is to get some relief from the pain if it is bad enough. This could involve the use of ice and NSAID’s to relieve the symptoms. The most important part of the treatment is the use wider footwear or modify the footwear to allow for less pressure on the big toe joint. This can be difficult if tight fitting footwear needs to be used in sports like soccer. Felt accommodative padding to get pressure off the affected area may be very useful. This felt padding could be shaped like a ‘U’ or a donut. This is needed so that there is no pressure on the area the symptoms are coming from. An injection of corticosteroid is sometimes needed to settle the problem. If none of this works, then a surgical removal of the affected nerve may be needed.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.