■ ■ ■ Description

Medial plantar nerve entrapment is a nerve disorder in the foot that causes pain and occasionally loss of feeling in the foot involving the first (big) and second toes. It involves compression of the medial plantar nerve in the mid-foot near the bottom of the arch by ligament-like tissues.

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■ ■ ■ Common Signs and Symptoms

• Tingling, numbness, or burning from the arch of the foot and traveling to the first (big) and often second toes

• Pain and tenderness along the arch of the foot, worsened by standing on the tiptoes of the affected foot or after running

• A feeling of the ankle giving way

• Symptoms that are worse (and sometime only present) during and after running on level ground

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■ ■ ■ Causes

• Pressure on the medial plantar nerve at the arch of the foot ankle caused by ligament-like tissue that covers and pinches the nerve

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■ ■ ■ Risk Increases With

• Recurrent ankle sprains

• Sports that involve a lot of running, particularly distance running

• Direct pressure on the nerve, such as with tight-fitting shoes, shoes with minimal padding, and loss of shock absorption or use of new arch supports (orthotics)

• Looseness of the joints of the foot, flat feet, or stiffness of the big toe (hallux rigidus)

• New arch supports that have high arches

• Medical disorders, including diabetes mellitus and thyroid disorders

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■ ■ ■ Preventive Measures

• Maintain appropriate conditioning:

  • Foot and ankle flexibility

  • Muscle strength and endurance

  • Cardiovascular fitness

• Use proper equipment, such as shoes and orthotics, and ensure correct fit.

• Taping, protective strapping, bracing, or high-top tennis shoes may help prevent ankle sprains and nerve stretching injury.

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■ ■ ■ Expected Outcome

This condition is usually curable with appropriate treatment, and sometimes it heals spontaneously. Occasionally, surgery is necessary.

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■ ■ ■ Possible Complications

• Permanent numbness in the foot and toes

• Persistent pain in the foot or ankle

• Inability to compete due to pain

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■ ■ ■ General Treatment Considerations

Initial treatment consists of rest from the offending activity and medications and ice to help reduce inflammation and pain. Removal of new arch supports or smaller, soft arch supports may be recommended if this is felt to be the cause of this problem. Cross-training or reducing the amount of running is usually of benefit. Stretching and strengthening exercises of the muscles of the foot and ankle may be useful. If this treatment is not successful, surgery may be necessary to free the pinched nerve. This provides almost complete relief, with full return to sporting activities in most patients. Training, while wearing orthotics, usually begins 6 weeks after the surgery.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary by your physician, usually only after surgery. Use only as directed and only as much as you need.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)