deep tissue toe blistering

[hikerpat]

About 8 years ago, I experienced lots of pain in the left fourth toe nail, laterally. The doc told me to not wrap it to protect it. His answer was to inject the 3rd metatarsal space (assuming there was a neuroma) - I will assume it was a sclerosing agent. Of course, this did not help. In Nov. 2009, I had a large (1" diameter) neuroma removed from this nerve space. The guy neglected to remove the remainder of the nerve that supplies the tuft of the 4th toe (which he had said he would do), so it continued to exchange nerve "information" with the 4th toe's lateral nerve. About 2 years later, this remainder of a nerve formed a stump neuroma (scar tissue). It then began to, alternately, make the deep tissue of the 4th toe blister, which was extremely painful. I put up with the pain during step aerobics and hiking, until I could not longer participate in these activities. In January 2013, it apparently had blistered twice, as it subsequently released 2 layers of skin, which clung to the end of the toe nail (the nail deteriorated tremendously after the neuroma surgery). I had 5 pain-free days, then it began again. That is where I now am. The skin looks as if there is a circulation problem, but the capillary refill is great. Air temp has no affect. The skin gets deep purple-red, with deep reddish blotches, that seem to be more blistering in process. The toe can get quite swollen. I had one night where I couldn't sleep, due to the throbbing and feeling as if it were on fire. As you can see from the pic, the 3rd toe is mildly involved - it shares in the stump neuroma problem.Does this condition have a name? "Whitlow" was suggested, but that type of toe is suppurative. I would appreciate anyone giving me a springboard from which to continue searching, or an actual name. Many thanks.

[hikerpat]

I thank you for taking your time to respond; however, I found it non-responsive. Infections: there are none; inflammations: clearly there are; scar tissue formation: that is what is a stump neuroma.
I am merely trying to do a bit of sleuthing on my own, to help myself, as not everyone - as is your assumption - able to pay for any kind of medical care. My church, who will be paying for whatever care there may be out there, does not want to waste the parishioners' money sending me somewhere I do not need to be. It will have to be either another podiatrist or a dermatologist. My money is on the foot doc, since it arises out of the 3rd intermetatarsal space, that has 2 stump neuromas. I don't need an extremely expensive U/S to tell me what I can feel with every step. Thanks, any way.

[S. Kaul, MD]

Hi there!

Well, without a detailed clinical evaluation it would be difficult to determine the cause of your symptoms. Possibilities that may need to be considered include infections, inflammations, scar tissue formation with possible compression of neuro-vascular structures etc. I would suggest getting this evaluated by an internist for an accurate diagnosis and appropriate management.
Hope this is helpful.

Take care!