Kevin and Bruce:

Thanks for that. The problem has certainly been in the first interspace with
classic neuroma symptoms.I have seen 3 cases in the past 3 months. The latest
case of a professional cyclist has improved with shoe modification and orthotic
but some symptoms still persist. I am planning to undertake an ultrasound scan
and probably combine this with a guided corticosteroid injection in the near
future.


Many thanks

Andrew Williams
Department of Musculoskeletal Science
University of Liverpool


 Quoting Kevin Kirby <[log in to unmask]>:

> Andrew and Colleagues:
>
> As Bruce mentioned, Joplin's neuroma generally refers to a neuroma of the
> medial plantar digital nerve of the hallux.  Neuromas or neuritis in the
> first intermetatarsal space are generally not very common and I would expect
> that the tight cycling shoes are the culprit for your patient's first
> intermetatarsal neuritic symptoms.  Next time, I would suggest having the
> patient get a larger cycling shoe for the initial treatment since this, along
> with some daily icing therapy, may be all that is needed to eliminate the
> neuritic symptoms.
>
> Cheers,
>
> Kevin
>
> ****************************************************************************
> Kevin A. Kirby, DPM
> Adjunct Associate Professor
> Department of Applied Biomechanics
> California School of Podiatric Medicine at Samuel Merritt College
>
> Private Practice:
> 107 Scripps Drive, Suite 200
> Sacramento, CA  95825  USA
>
> Voice:  (916) 925-8111     Fax:  (916) 925-8136
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