Left ring toe pain when walking

When we walk too much in our daily life, we often experience pain in the soles of our feet or toes. However, some people do not walk too much, but still experience pain in their little toes when walking, especially in the left foot. In fact, there are many reasons for this phenomenon, such as inflammation. Let’s take a look at the causes and treatments of pain in the ring toe of the left foot when walking.

Tenosynovitis

The tendon sheath is a double-layer, sleeve-like, closed synovial tube that is wrapped around the tendon. It is a synovial sheath that protects the tendon. It is divided into two layers that wrap around the tendon, and there is a cavity between the two layers, namely the synovial cavity, which contains tendon sheath synovial fluid. The inner layer is closely attached to the tendon, and the outer layer is lined inside the tendon fiber sheath. Together they are combined with the bone surface to fix, protect and lubricate the tendon, protecting it from friction or compression. If the tendon is excessively rubbed here for a long time, damaging inflammation of the tendon and tendon sheath may occur, causing swelling, which is called tenosynovitis. If left untreated, it may develop into permanent disability.

Causes

1. Radial styloid stenosing tenosynovitis

Two tendons pass through the first fibrous bone sheath on the dorsal side of the wrist, namely the tendons of the abductor pollicis longus and the extensor pollicis brevis. After passing through the narrow sheath, the two tendons form a certain angle with the sheath and end at the base of the first metacarpal bone and the base of the proximal phalanx of the thumb, respectively. When the wrist and thumb have a wide range of motion, the angle of the tendon increases. Over time, the local synovium becomes inflamed and thickened, the tendon becomes thicker, the fibrous sheath wall also thickens, and subcutaneous nodules appear at the radial styloid process, making it difficult for the tendon to slide in the sheath, causing symptoms such as pain. Due to endocrine changes in lactating and menopausal women, the synovium is easily affected and this is the main reason why the disease is more common in women. In addition to the above reasons, according to our surgical observations and foreign literature reports, there are many anatomical variations that can easily cause the occurrence of this disease. For example, if the belly of the palmaris pollicis longus or the extensor pollicis brevis is too low, part of the belly may enter the sheath; because there are more vagal tendons in the sheath, the number of tendons increases significantly, with some having more than ten tendons; there are also hard, thick and tough fibrous septa in the first dorsal wrist sheath, which makes the originally narrow sheath even narrower and the tendons are easily incarcerated. These anatomical variations cause the disease to occur at a younger age and make conservative treatment difficult to be effective.

2. Myosinitis

The radial extensor carpi longus and brevis muscles are located on the deep side of the proximal end of the dorsal carpal ligament, and the extensor pollicis brevis and abductor pollicis longus muscles pass through the superficial side at a certain angle. When muscles are overactive, the muscles, tendons, and the surrounding fascia and peritendinous tissues become congested and edematous. The synovial fibrinous exudate increases, and symptoms such as local redness, swelling, and pain appear.

Clinical manifestations

1. Radial styloid stenosing tenosynovitis

Also known as de Ouervains disease, it is characterized by pain on the radial side of the wrist that is closely related to thumb movement. This disease is more common in women over 40 years old, but it can also occur in breastfeeding women.

2. Stenosing tenosynovitis of the flexor tendon

It often occurs on the thumb, middle and ring fingers, and the age of onset is generally over 40 years old. In the early stage of the disease, snapping and pain occur when the fingers are flexed and extended, so it is also called "trigger finger". Patients often report inflexible joint movement and swollen joints. In severe cases, the joint is locked in flexion or extension, and the joint cannot be straightened or flexed. This disease occasionally occurs in children, with the thumbs on both sides in a flexed position and unable to be actively straightened. In mild cases, the thumb can be straightened through local massage when the child is asleep. In severe cases, the thumb cannot be straightened even passively.

3. Myosinitis

Also known as gravel myothelial myociitis. When wrist activity increases, redness, swelling, heat, and local tenderness appear on the proximal side of the back of the wrist, and pressure may produce crackling or snow-stepping sounds.

4. Ulnar extensor carpi tenosynovitis

It is one of the causes of ulnar wrist pain. The extensor carpi ulnaris tendon and surrounding sheath play an important role in supporting the distal radioulnar joint and the triangular fibrocartilage complex of the wrist. When the wrist is too active, repeated pulling or spraining may induce pain on the ulnar side of the wrist, especially soreness and weakness in the wrist when exerting force.

treat

1. Radial styloid stenosing tenosynovitis

When it is first diagnosed or the symptoms are mild, conservative treatment such as immobilization, physical therapy or local blockade can be used. If non-surgical treatment does not significantly improve symptoms or symptoms recur, surgical treatment can be used.

2.Stenosing tenosynovitis of the finger flexor tendons

(1) Physical therapy or local blockade is usually effective when the disease first occurs;

(2) Surgery can be used for patients with severe or recurrent lesions. The thickened narrow ring should be removed during surgery. The extent of the removal should be determined by observing that the thickened part of the flexor tendon is not blocked by the sheath when the fingers are flexed and extended.

3. Myosinitis

Most symptoms can disappear by immobilizing the wrist, applying local hot compresses, and performing local physical therapy or local blockade when necessary. If the symptoms recur over a long period of time, the peritendinous and synovial tissues become thicker, and local bulges occur, surgical treatment may be considered to remove the thickened synovium and fascia.

4. Ulnar extensor carpi tenosynovitis

In the early stage, immobilization or local closure is required, and in the late stage, synovectomy or partial sheath resection is performed. Similarly, similar symptoms may occur in the radial and ulnar flexor wrist muscles, often caused by corresponding tenosynovitis. If the disease recurs, patients may also consider surgical treatment.

prevention

Pay attention to maintaining correct posture while working, avoid excessive strain on joints, and take regular breaks.

1. When doing housework such as washing clothes, cooking, knitting sweaters, cleaning, etc., pay attention to the correct posture of your fingers and wrists, do not bend or extend them excessively; do not lift objects that are too heavy; do not use too much force on your fingers and wrists.

2. Do not work continuously for too long. After work, rub your fingers and wrists, and then soak your hands in hot water.

3. It is best to use warm water when washing clothes in winter. Wear cotton gloves when sweeping snow after it snows to prevent your hands from getting cold.

4. For those who work at a desk for a long time, they should adopt the correct working posture, try to keep both hands balanced, and keep their wrists touching objects instead of hanging in the air.

5. Rotate the wrist joint 360 degrees; or clench your fist and then relax it, do it back and forth several times, or press your fingers or palms back a few times, which can effectively relieve hand pain.

6. When you feel tired in your joints, you can take a hot bath to relax your tense muscles, or apply hot compresses to the sore areas. Frequent use of computers can easily lead to tendonitis.