Could a Foreign Object Be Causing Nerve Pain and Stiffness in My Toe?

Uncertain whether the foreign body has penetrated the nerve, causing numbness and tingling?

Hello Doctor: My "fourth toe joint on the left foot" and the "dorsal foot connection" were punctured by a foreign object (a transparent splinter about 0.1 to 0.2 mm) at the end of last year.
I have attempted to remove it multiple times without success, but I have a noticeable sensation of a foreign body every day.
About a month and a half ago, I went to a major hospital where a nurse performed a micro-slice procedure (making several incisions at the site of the foreign object), but the object was still not found.
After the wound healed, I still felt a prickling sensation upon touch.
Two weeks ago, the affected toe began to feel numb and tingly, the joint slightly swollen, and I was unable to bend it normally.
When attempting to bend, the first three toes can flex, but the fourth toe remains horizontal, and the fifth toe has some limited range of motion.
I consulted a dermatologist who recommended seeing a neurologist.
The neurologist took X-rays but could not locate the splinter (it is a non-metallic object).
I took antibiotics and painkillers for a week, but the numbness and inability to bend persisted.
Upon returning to the neurologist, I was prescribed the same antibiotics and painkillers, with added B12, but the condition remains unchanged.
After an orthopedic examination, my tendons were found to be intact.
I would like to ask: 1.
Is it possible that the previous micro-slice procedure did not successfully remove the splinter, causing it to become lodged on a nerve in the toe, leading to the persistent numbness and inability to bend the toe joint? 2.
Although there is no obvious hard lump in the affected area, I can pinpoint the location of the splinter by touch.
Could this allow for surgical removal? (I have no family history of related issues or drug allergies.) Thank you, Doctor, for taking the time to respond to my questions.

Jack, 20~29 year old female. Ask Date: 2021/06/12

Dr. Li Zhonghuai reply Surgery

Hello! If the exact location of the wound from last year's injury is known, nearby tissue can be excised.
Reactions to foreign bodies vary among individuals; some may encapsulate the object, while others may allow it to gradually surface.
When incised, it often feels like searching for a needle in a haystack, so it is generally recommended to excise the tissue surrounding the insertion site.
Take care! Changhua Hospital is concerned about you!

Reply Date: 2021/06/12

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding the persistent discomfort in your left fourth toe following the incident with the foreign object. Based on your description, it appears that you are experiencing a combination of nerve pain and stiffness, which can indeed be linked to the initial injury and the foreign object that remains embedded or has caused some form of irritation.

1. Possibility of Nerve Involvement: It is plausible that the foreign object, even if it was not successfully extracted, could have caused damage or irritation to the surrounding tissues, including nerves. When a foreign object penetrates the skin, it can lead to localized inflammation and, in some cases, nerve compression or irritation. The symptoms you describe—tingling, numbness, and difficulty bending the toe—are consistent with nerve involvement. The fact that you still feel a sensation of the foreign object despite attempts to remove it suggests that there may be residual inflammation or scar tissue that is affecting the nerve pathways in that area.

2. Surgical Removal Consideration: Regarding the possibility of surgical intervention, if you can pinpoint the location of the sensation and there is a clear indication of a foreign object being present, it may be worth discussing with an orthopedic or podiatric surgeon. They can evaluate whether a surgical procedure to explore and potentially remove the object is advisable. Even if imaging studies like X-rays did not reveal the object, other modalities such as ultrasound or MRI might provide additional insights into the soft tissue structures and any foreign material that may be present.

3. Continued Symptoms: The ongoing symptoms of numbness and stiffness, along with the inability to flex the toe, could also be indicative of a condition known as complex regional pain syndrome (CRPS), which can develop after an injury. This condition is characterized by prolonged pain and changes in the skin, hair, and nails in the affected area. It is essential to monitor these symptoms closely, as they may require a different approach to treatment, including physical therapy, pain management strategies, or even nerve blocks.

4. Next Steps: Given that you have already consulted with dermatology and neurology, and considering the complexity of your symptoms, I recommend seeking a referral to a specialist in orthopedic surgery or a foot and ankle specialist. They can perform a thorough examination and possibly recommend further imaging studies to assess the soft tissues and any potential foreign body. Additionally, they may consider a nerve conduction study to evaluate the function of the nerves in your foot.

5. Pain Management: In the meantime, continue to manage your pain with the medications prescribed by your healthcare provider. If the pain persists or worsens, do not hesitate to follow up with your doctor for further evaluation and adjustment of your treatment plan.

In conclusion, while it is possible that the foreign object is contributing to your symptoms, a thorough evaluation by a specialist is crucial to determine the best course of action. Please keep track of any changes in your symptoms and communicate them to your healthcare provider.

Wishing you a speedy recovery and relief from your symptoms.

Best regards.

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