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Fribroid tissue/deposits on a heel bursa sac

by Deena Lane
(Provo, UT)

About 6 1/2 months ago, I experienced trauma to the bursa sac on my heel from overuse (walking/running on a non-cushioning treadmill). I woke up the morning after the incident not able to even touch my foot to the floor. After 2 days on crutches and icing and anti-inflammatories, I was finally able to hobble around. After a week of it not resolving itself, I went to a podiatrist. He made orthodic inserts for my shoes and after 6 months, we still haven't been able to heal the bursa sac and get me complete relief. He is now saying that fibrous tissue has grown on the bursa sac causing it to not heal or reduce in size. He suggests surgically removing the tissue and the bursa sac (I am set to have the surgery on Sept. 11, 2009). I asked about massage or physical therapy but he said neither would "cure" the problem. He said the only way to remove the tissue is by doing surgery. He hasn't done an x-ray or MRI. What is your opinion? Are there other alternatives?


Hi Deena,
Without an MRI your doctor does not really know the status of the bursal sac, whether it is inflamed or fibrotic.
Physical therapy can be very helpful in these cases and he is right, you will never get rid of it because it is known as an adventitious bursitis, meaning it is a naturally occurring bursal sac that the body forms to act as a cushion. Your problem is that it is inflamed and you and your doctor have not been able to get it under control.
You have nothing to lose (and everything to gain) by trying physical therapy first. If it works, great; if it does not work, you can always have the surgery.
In my experience, physical therapy can be very effective.
Marc Mitnick DPM

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failed fusion of 1st metatarsal big toe

I had surgery a year ago to fuse the joint. Two screws were use. I developed a surgical infection and septacaemia!! One year later the toe is not fused. My surgeon took the screws out this week. For the first time in months I am not in pain and can walk without a surgical boot. Given the lack of fusion will I need more hardware in my toe. I do not WANT TO GO THROUGH THAT PROCEDURE AGAIN!!He wants to reoperate I am not at all keen

Hi,
Unfortunately you now have an unstable joint, but having said that depending on your age and activity level, if you find the foot does not hurt to walk and you wear a rigid soled shoe you might find that you can get by without further surgery.
Marc Mitnick DPM

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Tight, sharp pain in the top middle of my left foot.

by Shannon
(Geneva NY 14456)

Tight, Sharp pain in the top middle of my left foot. If I ware flat shoes or no shoes the pain is excruciating I can barley walk. If I ware high heeled boot its the ONLY time my foot dosnt hurt. Its hurts from the time I wake up to the time i go to bed. Its throbs with sharp tight pain, When walking I have to walk on the side of my foot. Ibprofine helps alittle. I had a cortisol shot in the top of my foot that did no good and I also ice it whenever I can daily. Please give me your best advice.

Hi Shannon,
See my section on
midtarsal fault
. Sometimes a cortisone shot alone will not alleviate the problem. Since the foot hurts more barefoot and in flats, chances are you will need some kind of arch support in your shoes. Make sure you see a podiatrist who will tend to be more familiar with this type of problem, more so than any other kind of doctor.
Marc Mitnick DPM

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Stiffness and aching feet

by Laura
(Oconomowoc, WI)

I'm 33 years old, very healthy and normal female that has always been active throughout my entire lief. I work out regularly, and have a two year old daughter who keeps me busy. The last few years I have had jobs that require standing quite a bit, and was "diagnosed" with plantar faciaitis about four years ago. Off and on since, I've had foot pain (started as heel pain) that comes and goes.
More recently in the past three to five months my feet have become achey and stiff and has progressively gotten worse. The stiffness generally is the worst in the morning when I wake up, but more recently is also bad when I sit down even just for a few minutes, and stand up again. Its to the point where I can barely bend my ankles when I stand back up, get out of bed, get out of the car, etc. My ankles and majority of each foot is extremely achey and stiff, and becoming a little bit sore to the touch as well... I limp around and look rediculous.
I will be going to the doctor shortly to discuss my issues, but I'm curious if there's something seriously wrong. I've read about different types of arthritis, MS, other auto-immune diseases, etc. It seems like a symptom of so many different problems, how will I know what I really have?

Hi Laura,
Your complaints sound more like osteoarthritis, the wear and tear arthritis we all develop as we age as opposed to an autoimmune disease.
You might want to try wearing an orthotic all day long; you may find it reduces the pain and stiffness that you experience when you first stand up (which is typical of osteoarthritis).
Marc Mitnick DPM

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Ankle Avulsion fracture ---migratory pain

by Jeanie
(Michigan)

I fell down some stairs 8 months ago and sustained an avulsion fracture of the talus and calcaneous bones. The doctor said I had a Chopart's sprain. I was on crutches in a boot cast, then an ASO brace until mid July.
I can walk now but cannot run a short distance without pain. Going down any stairs is painful and I have a lot of pain in different parts of my ankle. I have a throbbing pain in one part of my ankle, have pain in the top part of my foot when I sleep, have pain under my foot and in the heel bone when I stand or walk for more than 5 minutes.
I tried physical therapy but the pain was unbearable.
I have had several x-rays and an MRI that show that everything is fine.
I am not sure what to do now.

Please advise.

Hi Jeanie,
As I am reading your "story" I am thinking to myself that she should probably try Physical therapy and if that does not help then possibly an MRI. I get to the end and of course you have had both.
Have you had a cortisine injection in the area? Quite possibly the MRI is not giving an accurate reading on the prognosis of the fracture. In that case a bone scan might be indicated.
My philosophy is that any time the patient's progress does not match the lab work or radiology findings, then more investigation needs to be done.
Marc Mitnick DPM

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sharp pain and throbing

by vern
(ohio)

january 2009 i had pump bump surgery eight months later in still in more pain then before surgery i have daily pain the rear of my heal and around the outer side behind ankle has burning stabbing and throbbing every day i have had monthly visits to the orth-nuero doctor he continues to tell me to hang in there. i have since seen a foot spec. he felt i needed another surgery that enough of the spur had not been removed ,but i really didnt want to go thru that again so we tried 20 sessions of p-therpy 3 cortison shots at different times and orthodics. i hurt everyday about a pain level of 3-6 . i really would like a suggestion cause im tired of the pain and going broke from all the doctor copays.do you think a mri would tell anymore than the xrays,i asked for one the doctor said we could but has yet to get it set up for me . could this just be scar tissue and inflamtion the doctor told me he removed bursae sac.

Hi Vern,
Well obviously you have problems and yes, one possible problem is that not enough bone was removed. There is also the possibility that the bursal sac is still there, along with scar tissue, possible nerve entrapment and possible partial detachment of the achilles tendon (just to name a few of the potential problems.)
I think an MRI would be in order as it will give a more detailed picture of the soft tissue structures that are in the area and will point out any abnormality in soft tissue structure.

Marc Mitnick DPM

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Numb-like Sensation in fourth toe

by Ron Russell
(Pacific Grove, CA)

About two years ago I developed a numblike sensation in the pad of my fourth toe only on the underside. It was very minor so I ignored it for two years owing to other major health problems. Last Fall, I decided to see a podiatrist who injected the site with Lidocaine and a steroid. After the injection, the problem became at least five times worse. Now I have a constant feelings of numbness encompassing a larger area. I still can feel temperature and the sensation of touch, so the word "numb" is not completely fitting. Any suggestions? Thank you for your kindness and your site.

Hi Ron,
What I would assume happened is that a diagnosis of Morton's neuroma was made as the cause of the numbness. The cortisone injection was attempted to reduce the irritation of the offending nerve, but probably what happened was that the needle was injected directly into the nerve further aggravating the conditon.
There is treatment for the problem, assuming it bothers you enough. My suggestion would be to see a podiatrist and discuss your options with he or she.
Marc Mitnick DPM

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itchy feet

by teri
(Texas)

for about a week now when i wake up in the morning and stand as i'm brushing my teeth the top of my feet will start to itch. at first i thought somthing was biting me, but no such thing is happening. i scratch and will rub them and after about 5 to 10 minutes it goes away. this morning i decided to sit in bed before standing, massaged my feet and to my surprise the itching sensation went almost unnoticed.

what can this be? i'm not overweight, i compete in natural bodybuilding and eat pretty clean. recently had some blood work done and found that my platelets are elevated. could this have something to do with the other?

My doctor is still working on pin pointing the elevated platelets.

thanks!

Hi Teri,
My first thought would be a nerve irritation that is occurring from the way you sleep, then stand. Once standing for a short period of time the itching goes away. That is probably why massaging the feet first before getting out of bed alleviated most of the problem.
I assume you are reasonably young since you compete in natural body building so I do not think it is a vascular problem.
This problem may subside in a short period of time, but if it does not, have it checked out by a doctor.
Marc Mitnick DPM

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Treating white superficial fungus

First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Second, your argument for Formula 3 is convincing, but I'm not clear whether it applies to white superficial fungus. For superficial fungus, do you think that using an emery board to abrade the nails and then applying Fungoid is sufficient? Or do you think that even for superficial fungus Formula 3 or some other prescription or over-the counter lotion/polish works better?

Thanks.

Hi,
If you only have superficial fungus then I think just sanding them and applying any over the counter antifungal medication should be more than adequate.
However, if that does not control it and the fungus begins to burrow down into the nails then you will need to consider either Formula3 or perhaps oral medication.
Thanks for your kind words about this site; I try.
Marc Mitnick DPM

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stiff and hurting toes 6 months after hammertoe surgery

by beth smith
(baltimore ohio)

I still have problems with my toes hurting and they are still stiff and alot of numbness too as well.

Hi Beth,
It would not uncommon to still have some post surgical discomfort after six months, but it seems you may have more than would be considered normal.

Everyone heals as a different rate. If you find that the toes are no longer further improving and progress has stagnated then I think a conversation with your surgeon would be in order.

Physical therapy may prove to be helpful, particularly for the stiffness.

Marc Mitnick DPM

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Outside foot pain, tendonitis?

by Steve
(NYC)

I am an extremely active, 25 yr old man who runs, lifts weights, plays basketball daily.

I ran about 4 miles on MLK Jr day, with no pain. 24 hours later, I had some substantial sharp pains running along the outside edge of the foot, down to my pinky toe.

It is tender to the touch right on the spot your yellow arrow points to (picture attached).

When I invert my foot, no pain. When I extert the foot, I have some pain. I weigh 215 lbs so when I walk I do have pain. Xrays were negative, as I was suspecting a stress fracture of fracture of the 5th meditarcil as I sustained that injury many years ago.

Is this tendonitis or is there a risk of a tear? There is no swelling, and no redness.
Thanks

Hi Steve,
It may very well be a tendonitis. Since the xrays were negative for fracture, I would suggest you try a round of immobilization and anti-inflammatory medication (assuming you can tolerate that type of medication) for about 10-14 days. Youth is on your side and it should remedy itself fairly quick.
Marc Mitnick DPM

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my second toe on right foot is numb

by edith
(SACRAMENTO)

my second toe on my right foot has been numb for 24 hours. i did not injure it in any way. i am concerned what do you suggest?

Hi Edith,
Give it another 24 hours, if it is still numb then you may want to seek medical attention to find out what is causing it.
Marc Mitnick DPM

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Foot Problems

My Husband has been suffering for alot of years,with painful feet. First he is flat footed do to his National Guard Service. He developed,hammer toes,and bunions. The big toe goes under the toe next to it,(the hammer toe),in turn the hammer toe is pushing down on the big toe,causing the toe nail to dig into his big toe. He has such a build up of callus on both feet,which in turn is causing him more pain. The bunions on the big toes are big. I try to scrape the bottom of his feet to remove some of the build-up,so he has a reprieve of some of the pain for a short time. Yes he has delevoped corns,and possible planter worts. Worts ???? With the twisting form of his feet,the underside of foot,is causing a deep crease where the big toes and the next one to it seperate. These creases on both feet are now cracking open,and It has me so worried. I do put antibiotic ointment,and cover the break with a bandage. Surely he needs attention,and at the present we've no insurance at this time,but he has applied through his employment,but it won't take effect until after the first of October. I try to keep his feet as clean as possible,but I still am afraid of infections. I've no picture,but I am sure you can visualize his problem,pain,etc.

Hi,
I have seen his situation many times before. Until you get insurance, go buy a good pair of arch supports to more evenly distribute his body weight, use a pumice stone to get rid of the callus build up as best you can and put cream on his feet twice a day to keep them hydrated.
Marc Mitnick DPM

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Lump on top pf right foot numb and tingly about the diameter of a nickel

by Gayle
(Las Vegas)

I have a lump on the top of my foot that has a weird sensation it sort of feels numb and tingly when touched. It does not hurt but if touched you can feel a strange sensation in my toes. I have not injured my foot. My medical background includes SLE I am 59 years old Black and Female. It just showed up I have no idea what is wrong it recently started bothering me tingling smarting etc.

Hi Gayle,
Sounds like an inflammation of the superificial nerve that travels on top of your foot, just under the skin. It usually gets aggravated from a shoe pressing the nerve into the underlying bone. If you tap on the area it will send a tingling sensation into your toes.
See a podiatrist, a cortisone shot may go a long way to relieving the pain.
Marc Mitnick DPM

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cuboid syndrome

by Kathy
(Watertown)

2 yrs ago I had a level 4 lateral sprain w calcanas fracture. Unfortunately I didn't have it taken care of right away & when it was finally diagnosed it wasn't treated correctly (some my fault some the docs). My foot wasn't immobilized until over a month after the initial injury. After I got out of cast & started physical therapy I consistently had significant pain on lateral side of foot, very sharp when weight bearing & doing therapy, aching/throbbing otherwise. I was progressing w therapy well except for localized pain. MRI was neg for stress fracture. Was given diagnosis of Cuboid Syndrome and told to stop any weight bearing exercises and given some foam to place on insole under cuboid area. This helped initially in quieting inflammation. Anytime I try any exercise w impact, prolongued walking, significant movement of foot, or even stairs, I still get sharp pains in the foot and the foot often aches & throbs. Any suggestions? Is it to late for manipulation, would a fitted orthotic make a difference, would wrapping arch make any difference. Any suggestions would be greatly appreciated.

Hi Kathy,
If the foam helped initially then I think an orthotic with a cuboid pad built into it should give more substantial relief. This along with physical therapy would likely result in a great improvement.
Marc Mitnick DPM

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