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Foot Pain, MRI Results Included
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toepain2013
Foot Pain, MRI Results Included

Greetings,

About 1 year ago my feet took a betting during an assault where I was in bare feet on hard pavement. My feet were bruised and cut, I had a displaced fracture of my left pinky toe, and it was painful to walk on either feet for ~ 2-3 weeks.

Since then, I've had a number of problems with my feet:

1. Standing is exceptionally painful. I feel pain in my heel, forward arch and the ball of my foot. It feels like I'm standing directly on the bone.

2. Occasionally I get stinging / zapping sensations in the very tips of my toes.

3. Occasionally I get pain across the top of my foot, just below the toes (where the toes meet my foot).

4. When walking, it feels like there's a pinching sensation in the ball of my right foot. Standing / walking aggravates this, and also tends to cause pain in the tip of my third and fourth toes on the same foot.

5. I also have some lower shin pain (shin splint style).

6. My feet tend to feel tender barefoot. I can handle it, but it doesn't feel great walking around barefoot.

The pain gets better with rest, and doesn't get worse at night.

I've seen a podiatrist for about 6 months for the issue. He recently ordered an MRI of my right forefoot. The results are as follows:

Small effusion of the first MTP joint with cartilage thinning and irregularity and small foci of subchondral marrow edema with tiny marginal osteophyte formation. No erosive change. No significant arthritic change identified in the remaining MTP joints.

Trace amount of fluid in the region of the first, third and fourth intermetarsal bursae.

My podiatrist thinks that in the trauma I caused damage to the big toe joint, and since then I've been compensating by overloading my third and fourth metatarsals. He thinks that's why I've developed the pain in that area. He didn't, however, have any solution for the issue. He said he'd suggest physical therapy, but he doesn't see any value to a steroid injection or anything of that nature. Basically he told me to "live with it" and that I'm going to have to accept that as long as I stay active, I'm going to have this type of pain.

So, a few questions for you:

1. Do you agree with his diagnosis (I realize you can't examine the foot, but with the description of the symptoms + MRI is there anything else you think might be going on)?

2. I'm a very active person and enjoy weight lifting 5 days a week. It's not high impact weight lifting, but I do perform things like squats and deadlifts at heavy weight. Do these things put enough pressure on the feet that I might be re-injuring some strained muscles / joints in the area, thus causing the pain?

3. I walk about 2 miles a day getting to work (and stand on the bus). The pain is generally pretty bad during this process. Could even this be aggravating the issue?

4. Would it be beneficial for me to try taking 1-2 weeks off of work AND weight lifting -- basically focusing on rehabbing my feet by avoiding any use of the tendons / joints and such?

5. Do you see any value in trying a steroid injection?

I really just want to get back to normal. I'm only 28 years old and in great health otherwise. I'd love to get back to being fully active and pain free, but after a year of struggling with this I'm feeling pretty dismal.

ESplichal

Thank you for your question. Please note that without examining you I am basing my recommendations on your descriptions and MRI. To answer your questions I actually do not think that the MRI findings regarding the great toe joint are related to your initial injury. The MRI is describing what sound like chronic changes to the great toe joint (which is very common).

To answer your questions, I would suggest doing an injection to see if this can alleviate the intermetatarsal bursas that are indicated on MRI. I would also recommend doing daily calf stretching and foot massage on golf balls, a lacrosse ball or something similar. Sounds like the standing, walking and exercise you are doing are creating many restrictions and adhesions in your feet. This also is very common and will resolve with the stretches and foot massage.

Time off may give you relief but this is not the only answer. You still have to do stretches and daily recovery, otherwise as soon as you return to work and the gym, your symptoms will return. You may also want to consider orthotics or inserts to give you a little extra support.

I hope this helps!

==============
Dr. Emily Splichal
Please be advised: we do not provide medical advice, diagnosis or treatment.
By law, we cannot give specific medical advice over the Internet.


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