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QUERIES (CLINICAL)

05/03/2012     




Query: Numbness and Blue Discoloration of Hallux

A 25 year old well-developed, well nourished male presented with a complaint of "numbness" in the right hallux and "blue discoloration" when wearing shoes regardless of type for one week's duration. He wakes up every 5 hours and places the toe in warm water until normal color returns. He teaches barefoot during the day. There is no pertinent medical history. He has been an active runner and hiker, running 100 miles per week but has ceased any physical activity.
 
PE reveals absence to pinpoint pain sensation at the distal tuft of the hallux and decreased temperature. All other sensations are intact. The entire hallux is NOT involved. There appears to be a positive Mulder's sign in the 2nd interspace and pain on palpation plantar to the 2nd met head. I ordered radiographs today. Any thoughts on a diagnosis and treatment?

Chuck Ross, DPM, Pittsfield, MA