Severe episodes of pain the middle toe

Dear Ask The Doctor: My daughter is 24 years old. From time to time she gets a pain in her middle toe that she explains " it feels like someone is pulling my toe straight out, and the nerve is stretching". It is very painful she can't walk or even bend it. It happens with or with shoes on and lasts for at least 5 min. After it starts to slow down it still is stiff and sore for a long time. It may not happen for another week or it may happen in two more days. During the episode I massage the top of her foot in the opposite direction of how the toe is being pulled and keep sliding my finger up toward the shin and she says it makes it feel better and it won't last as long.

Dear Diane: According to your description, possibly your daughter may have a 2^nd MTT overload Syndrome; this produces pain in the distribution of the interdigital nerve secondary to repetitive irritation of the nerve. The most common presenting complaints include pain, which is sharp and burning, and it may be associated with cramping. This is known to develop as a result of chronic nerve stress and irritation, particularly with excessive toe dorsiflexion (toe upward) with activities such as prolonged walking, running, squatting. The conservative treatment for 2^nd MTT overload Syndrome involves footwear modifications: soft-soled shoes with a wide toe box and low heel. The next step is altering the alignment and elevation of the metatarsal heads which is achieved by wearing a plantar pad. This prevents more compression and irritation of the digital nerve and takes stress off the 2^nd MTT and plantar fascia. Also a physical therapy program can be beneficial and may include: local cold packs (icing), ultrasound, deep tissue massage, and stretching exercises. The corticosteroids local injection is another treatment option that might be considered.