Re injured foot: first a puncture wound then a car accident

Dear Ask The Doctor: I stepped on a nail back in October, right on the ball of my foot. The wound closed up, but I never regained full movement of my big toe. Three weeks later I was in a car accident, and the same foot was sprained due to the floorboard buckling. My whole foot is healed up EXCEPT for that big toe. I can put 95% of my weight on the ball of the foot but the big toe only has 50% movement. X-rays after the accident showed nothing as far as the puncture. Urgent care doctor said its just tissue damage. What can I do to have the movement back and pain eliminated?

Dear Jared: According to your description, most likely you may have a Morton’s Neuroma, which is not a true neuroma, it produces pain in the distribution of the interdigital nerve secondary to repetitive irritation of the nerve. Possible cause of the irritation of the nerve: the previous puncture wound. The most common presenting complaints include pain, which is sharp and burning, and it may be associated with cramping. Morton's neuroma 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 both: 2^nd MTT overload Syndrome and Morton’s Neuroma) 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.