Joint Swelling and Numbness After Topical Ointment Use

After applying Ganderson ointment, the joint of the left foot's little toe is swollen, and the entire leg is numb?

Dear Dr.
Wu,
I have a foreign body (fibrous splinter) near the joint of my left foot's ring toe.
At the beginning of May, I went to a large hospital for a skin biopsy.
They administered several injections of anesthesia at the joint and removed some epidermis, resulting in a wound approximately the size of half a pinky finger.
The doctor prescribed SPIERSIN Ointment, and during this period, the wound gradually healed without discomfort.
About two weeks later, I stopped the medication, and the wound developed a noticeable scar (appearing bruised).
By the end of May, I still felt a prickling sensation from the foreign body.
After applying GENTASONE CREAM from another clinic, I experienced significant swelling at the ring toe joint (appearing claw-like), and the joint of my pinky toe also swelled.
The ring toe joint became stiff, and bending it caused significant soreness in the dorsum of the foot and the joint area.
The nail of my pinky toe also became deformed and curled upward due to the swelling, prompting me to stop the medication immediately.

The next day, I woke up to localized mild numbness (at the junction of the ring toe and the dorsum of the foot), which lasted all day.
Two days later, I consulted the clinic again, and the doctor prescribed CIPROSONE CREAM 0.5MG/GM, but after application, it was ineffective, and the numbness increased.
Over the next two days, the numbness worsened, and I experienced a tingling sensation while standing, sitting, or lying down, making walking very uncomfortable and severely affecting my sleep.
I suspected nerve damage.
I then visited a large hospital's neurology department, where the doctor prescribed PARAFLEX CAPSULES 500MG "PANBIOTIC," Famotidine F.C.
Tablets 20mg "CYH," and Cataflam S.C.
Tab -25mg.
After taking the neurology medications for two days, the numbness in my left foot showed no signs of improvement and continued to increase.

Yesterday, I decided to use SPIERSIN Ointment again, thinking "to counteract the medication with medication." After applying it for less than 10 minutes, the swelling and numbness significantly decreased; however, the toe joint still exhibits abnormal curvature (claw toe), and there remains a certain degree of numbness in the dorsum of my foot and calf.
It has only been about seven days since I applied the GENTASONE cream, but at one point, the numbness in my left foot was so severe that I could barely walk, which frightened me greatly.
I would like to ask you:
1.
Could it be that the wound is still deep (at the site of the anesthesia injection) and has not healed, leading to the use of GENTASONE cream penetrating deeply into the skin (affecting nerves and bones), resulting in localized "peripheral neuropathy" and "infection/bacterial arthritis"?
2.
I am considering visiting a rheumatology and immunology department regarding the joint issue; do you have any better recommendations for specialists?
3.
Do you have any other suggestions or possible causes for my condition?
I apologize for the lengthy inquiry, and I sincerely appreciate your taking the time to respond.
Thank you.

Liang, 20~29 year old female. Ask Date: 2021/06/04

Dr. Wu Yuxin reply Dermatology

1.
It is impossible to determine without actually seeing the lesion.
2.
You should first consult an orthopedic specialist.
3.
Seek medical attention first.
The subsequent questions are hypothetical.

Reply Date: 2021/06/04

More Info

It sounds like you’ve been through quite a challenging experience with your left foot, particularly with the swelling and numbness following the use of topical ointments. Let’s break down your concerns and address them systematically.

1. Understanding the Reaction to Topical Ointments: The swelling and numbness you experienced after applying Gentasone cream could be attributed to several factors. Topical medications can sometimes cause localized allergic reactions or irritations, leading to inflammation and swelling. The fact that you experienced significant swelling and a change in the shape of your toe (claw toe) suggests that there may have been an inflammatory response to the cream. Additionally, if the wound was still healing, the application of a new ointment could have exacerbated the condition, especially if it contained ingredients that your skin or underlying tissues reacted negatively to.

2. Potential for Nerve Involvement: Given your symptoms of numbness and the inability to bend your toe, it’s possible that the swelling could be compressing nearby nerves, leading to a condition known as peripheral neuropathy. This could be a result of inflammation or swelling in the area, which might be pressing on the nerves that innervate your toes. If the swelling is significant, it could also lead to a condition called compartment syndrome, where increased pressure within a closed muscle compartment compromises circulation and function.

3. Infection or Joint Issues: Your concern about possible infection or septic arthritis is valid, especially if you have a history of surgery or trauma to the area. Signs of infection can include increased redness, warmth, and systemic symptoms like fever. If you suspect that there might be an infection, it’s crucial to seek medical attention promptly. A rheumatologist could help assess for any underlying inflammatory or autoimmune conditions that could be contributing to your symptoms.

4. Next Steps and Recommendations: Given the complexity of your symptoms, it would be wise to consult with a specialist who can provide a comprehensive evaluation. A rheumatologist would be appropriate, but you might also consider seeing an orthopedic specialist who focuses on foot and ankle issues. They can assess the structural integrity of your foot, evaluate for any potential fractures or dislocations, and determine if there’s any need for imaging studies like an MRI or ultrasound to visualize the soft tissues and joints.

5. Management of Symptoms: In the meantime, managing your symptoms is essential. Resting the affected foot, elevating it, and applying ice can help reduce swelling. Over-the-counter anti-inflammatory medications, if not contraindicated, may also provide relief. However, it’s crucial to follow your healthcare provider's recommendations regarding medication use, especially since you’ve been prescribed various treatments.

6. Monitoring Your Condition: Keep a close eye on your symptoms. If you notice any worsening of numbness, increased pain, or new symptoms such as fever or chills, seek medical attention immediately. Documenting your symptoms and any changes can be helpful for your healthcare provider in determining the best course of action.

In summary, your symptoms following the use of topical ointments warrant careful evaluation to rule out any serious complications, including nerve damage or infection. Consulting with the appropriate specialists will help you receive a tailored treatment plan to address your concerns effectively. Thank you for sharing your experience, and I hope you find relief soon.

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