Troublesome pain on the outside of my foot

by Ed
(Los Angeles)

I started having a troublesome pain (not very painful) on the outside of my foot. It starts either just below the ankle joint or about an inch from there and runs down toward the side and front of my foot. It seems pretty localized. I think it may have been caused while helping my daughter's team practice volleyball but I not sure. In any event, if I elevate the inside of my foot slightly (more weight on the outside of the foot) the pain lessens. If I walk normal, the troublesome pain starts to appear. If I raise my foot and twist/turn my foot inward or outward it bothers -- not right away but only as I start reaching the limit of my twisting capacity. It is not swollen or red, or a sharp pain.

Q: Does it sound like I injured/overextended a tendon and will icing on & off for the rest of the day make this go away, or should I be using a heating pad instead?

Hi Ed,
Yes, it does sound like you may have injured one of your peroneal tendons, but that diagnosis is made on the information you are supplying me with.
My rule of thumb: ice for the first 24 hours after an injury in an effort to reduce inflammation and thereby pain.
After 24 hours I Recommend heat. Heat causes an increase of blood flow into the injured area and it is blood that brings down the nutrients that allows the injured area to heal.
Moist heat would be better than a heating pad.
Marc Mitnick DPM

RE: bottom of foot pain while working out.

by Melissa
(Clermont, GA)

I am a 28 year old female. I just gave birth 6 months ago and I have been working out for almost two months now (4-5 days a week), mostly aerobics classes. Three weeks ago I began having a sharp pain in my right arch with every step and that went away. The following week while in my work out classes I started getting major achy pain in the bottom of both feet when the workout gets intense and it is still occuring. It almost feels like my feet are not getting circulation. I've tryed to loosen my laces, bought q factor replacement insoles, and even bought new shoes. Now I'm wondering if I need a wider shoe or if it is because I have so much weight and pressure on my feet. I weight 185lbs and I'm only 5'2". I hate to have to make a Dr's appt. if it could be a simple fix but I'd really like to be able to push myself in these workouts. However; this foot pain makes me stop and shake the pain out. This pain also comes while running or working out on the elliptical. Thank you!

Hi Melissa,
I cannot make a diagnosis for you but I can tell you this. If you are doing an activity that makes your feet hurt and you do nothing about it, you do run the risk of worsening the condition and ending up with pain all the time.
I think your best bet would be to see a podiatrist and get some treatment or at least an evaluation of what is going on, in order to avoid problems down the road.
Marc Mitnick DPM

Response from above heel pain

by Katherine
(Louisiana)

I had an MRI done and nothing showed up. I also have orthotics but can't wear the because it puts too much pressure on the area where my pain is. I also wear a night splint and started wearing an arch brace. Also I have no actual heel pain just the shoe string feeling above the heel going across.

RESPONSE

Hi Katherine,

First, orthotics can be adjusted and obviously yours need to be adjusted. A good orthotic does not put pressure on the heel. If your orthotics happens to be of the plastic variety then they are going to do more harm than good. You need an orthotic that not only supports the plantar fascial ligament, but, also cushions the heels.
Secondly, has a heel neuroma been ruled out. This is very commonly overlooked as most doctors make a diagnosis of plantar fasciitis or heel spur and do not look beyond that diagnosis.
Short of that, I cannot be of any additional help without the luxury of actually examining you.

Marc Miitnick DPM

Stumped toe

by Ana Ball
(Bristol, England)

I stumped my toe about 7.30 this morning and it is vey painful. It is now swollen and turning black and blue, as well as the foot area around it.

Does this mean it is broken or bruised or something along those lines?

Thanks

Hi Ana,
The only way you will know if it is broken is to have an x-ray; you cannot make that diagnosis just by looking at the toe.
Marc Mitnick DPM

tarsal tunnel syndrome

by Donna
(Downingtown, PA)

During an examination by a nurse practitioner, a member of my family practice group, she knuckled my arch which caused instant severe pain. I have been later diagnosed with having Tarsal Tunnel Syndrome. Is it possible that her examination caused this syndrome?

ANSWER
Hi Donna,

I doubt that knuckling your arch caused tarsal tunnel, particularly since the tarsal tunnel canal is more in the area just below the medial malleolus (the medial ankle bone) and not in your arch.
There is always the possibility that the knuckling injured something directly in that area but I do not think it would be mistaken for tarsal tunnel.
If you have tarsal tunnel syndrome, this is something that usually takes a while to develop, in many cases from the way you walk, particularly flat-footed.
In a foot that flattens out too much (over pronates), that creates a jamming on the outside of the ankle and a stretching on the inside of the ankle. It is this stretching that puts pressure on the ligament over the nerves in the tarsal canal. This ligament then puts pressure on the nerves and you end up with the symptoms of tarsal tunnel.
There are other situations that can cause tarsal tunnel, such as trauma itself to the tarsal canal or perhaps a growth of some sort that also puts pressure on the nerves as they pass through the canal and will give the neurological symptoms as well.
You do not mention if you are still having severe pain where the foot was knuckled so I do not know if that warrants any discussion.

Marc Mitnick DPM
DISCLAIMER

top of left foot hurts

the top (around middle) part of my foot just started hurting yesterday. it hurts when i move my toes up and when i press it or walk. i have flat feet, but i hate wearing the supports. could it be because of that?

Hi Michelle,
Put the supports back in your shoes and if the pain goes away in a few days you will then know that the pain was from not wearing the orthotics. It sounds like you may have a midtarsal fault.
Marc Mitnick DPM

Two Neuromas

by Missy
(Ohio)

Hi,

I have 2 neuromas in my left foot. They are very painful and I have tried the anti-inflamatory injections and the series of 7 alcohol injections and started the alcohol injections again but decided to quit after the 2nd because I was seeing no results from them. The doctor recommends removing the neuromas but says they can not be removed at the same time because of running the risk of injury to an artery? Does this sound right?

MRI revieled that the neuromas are 8-10mm's at the 2nd and 3rd IMS djd 1st mpj and sessmoids. Capsulitis 1-4 mpj.

I am going for a second opinion because I just really do not want the surgery, but and sick of dealing with this. It has been going on for 1 1/2 years. It is getting in the way of my working out because of the pain.

What would you recommend and does what the 1st doctor says make sense?


Thanks,


Missy


Hi Missy,
I would recommend the surgery is nothing else has helped and you are in a lot of pain. The notion of worrying about the artery, in my opinion, is a bunch of nonsense.
Why would he subject you to two hospital visits and two rounds of anesthesia?
Secondly, the biggest issue when you remove two adjacent neuromas is that enough room be left between the two incisions, so that the skin in between does not necrose (start to die because of lack of blood flow to the skin).
Over the years I have removed adjacent neuromas at the same time and have never had a problem.
Go get that second opinion.

Marc Mitnick DPM

Second toe swelling and tenderness

by Susan
(MA)

I have swelling and tenderness in my second toe on my right foot. The swelling occurs for a few hours after I wake up in the morning and has occurred for about 2 weeks now. I am 22, a healthy weight, and have a normal activity level. I usually like to go out for runs or walks, but for the past 2 months I have not (due to the winter), so I do not think it is related to activity.

I also have tender spots/little swells on a few of my other toes and my pinky, ring, and middle fingers (usually around the furthest joints). I have raynaud's syndrome and my hands and feet get very cold and are often discolored and turn purplish, and white. I am not sure if this is related at all.

Are the swelling and tenderness something I should be concerned about or does this problem normally go away?

Hi Susan,
Because you are young I do not think there is a major problem going on, you are probably experiencing side effects of your Raynauds in the cold weather.
The problem is you run the risk of these discolored spots breaking down and becoming infected.
Since I cannot examine you, I have no idea how bad the condition is, so I would suggest you visit a local podiatrist and let he or she assess your risk.
Marc Mitnick DPM

Toe cellulitis

by Marcie Wolf
(Kansas)

My daughter has had toe cellulitis (staph) since 2/10/09. Has been treated with 2 rounds of Keflex, 1 round of Augmentin, bactroban and tinactin ointment, soaked in clorox and epsom salt and washing with dial soap. It cleared up after the 1st round of Keflex but come back and has not cleared up since. Toe is hot to touch, hard to move and very red. Please help!

Hi Marcie,
More than likely the toe nail will have to be removed. What generally happens in these cases is that while on the antibiotics the infection is suppressed giving the appearance of improvement, once off the medication the infection returns in full force.
By removing the nail (and allowing it to grow back), the source of the infection can be cleaned out and with the help of antibiotics, the infection should clear up once and for all.
The last thing you want to do is to keep your daughter on a constant regimen of antibiotics.
Marc Mitnick DPM

titanium screw has become loose after bunion and hammer toe surgery

I ahd bunion surgery om March 12th 2010 and I have not being able to walk on my foot since. I was weightbearing for 6 weeks and when back to my surgeon to have my hammer toe pin taken out and also my foot xrayed. I was discharged from the clinic and was told the only prpblem i would have was swellin for maybe 6 mnths. When i tied to walk on my foot I found it extremely painful and have been walking on my heel ever since. I finally got a appointment to go back to the clinic and was exrayed again and was told the pin was so out of place I may need to have the hardware taken out and redone again. I am extremely depressed over this . The screw is also coming through the ball of my foot and is really painful if i touch it .Could you advise me how that so soon after i was discharged that the screw became so out of place . Thanking you.

Hi,
In general terms, the screw was probably never properly placed in the first place. This can happen with "hardware"; at the time of surgery it may appear to be well placed but once there is stress placed against it, the screw may come loose.
This problem will happen to most of us who place metal hardware in an effort to stabilize a fractured bone.
Assuming the bone has properly healed, then the hardware may be removed. Although, yes, it does require another operation, this procedure should not be as involved as the original surgery.

Marc Mitnick DPM

Second opinion on lump?

by andreasmom02
(VA., USA)

Hi, I'm a 29 year old female who found a small lump on the outside of my right foot about an inch under my ankle a few months ago. The lump is about 1 cm in size. The lump is kinda boney, and seems to transilluminate with a flashlight. Following your advice from a previous post, I recently seen a local orthopedic surgeon about it. In my medical records the doctor's diagnosis states:

"Three views of the right ankle & hindfoot demonstrate no calcification in the area of the soft tissure mass. I don't see any evidence of recent or remote fracture. No problems with the peroneal tendons seen. This little area of bony or soft tissue swelling is associated with a litle bit of hypertrophy in the peroneal tubercle, but since it is not causing pathology with the peroneal tendons, I don't think it needs excised. The other possibility is that this may be a small ganglion cyst associated with the peroneal tendons. I will treat this with observation. I will see the patient p.r.n."

The doctor only did an x-ray. She didn't do an MRI or biopsy. The medical records almost sound like she gave me 2 different diagnosis'. Should I seek a 2nd opinion? Or does this sound like a good diagnosis?

Hi,
In general a well rounded "growth" is usually a benign growth (noncancerous) and can be left alone. The only reason you might want further treatment would be if it begins to hurt, otherwise you can probably live with it. Should it start to enlarge, that would be another reason to seek further medical care.
Marc Mitnick DPM

swelling in my ankle and toes

I had surgery on 5/11/10. I broke my tibia and fibula had to have orif to fix it. I keep my foot elevated but I have sat and tried to cook dinner, I DO NOT stand or put pressure on it. my toes turn a dark color, blue/purple and it throbs. Is this normal and I doing too much too soon. I have a hard cast on right until I go back to the dr on 6/17/10.

Hi,
If you have any concerns you should always ask your surgeon as he or she is responsible for your care, but just looking at the picture, the bruising and swelling that I see do not look out of the ordinary.
If you are having any pain in the calf area, I would suggest you make your doctor aware of that as well.
Marc Mitnick DPM

swollen red toes

by Lila M

The toes on my right foot are swollen and red (except the third toe). This has been going on for a few weeks, but I recently noticed that they seemed to have increased in redness and swelling. It was originally just a few toes on my right and a few toes on my left foot, but the left foot is looking a lot better (with very mild swelling/redness especially compared to the right one).

I changed climates drastically about 5 months ago, from hot and dry to very cold and damp. As a result, I have been wearing thick socks, sometimes 2-3 pairs, and I think that maybe because my feet haven't been "breathing" properly they got athelete's foot or some other infection. But I don't think my symptoms really match that of athlete's foot, because there's no flaking of the skin, and not excessive itching all the time.

The time they itch is when they get hot and sweaty inside my layered socks, or when I put them in a warm water bath (I have been trying to do that nightly). Otherwise no itching. The only pain/discomfort I feel is when I press on my swollen toes.

Do you think it could be superficial frostbite? I remember a few distinct occassions when my toes "froze", or at least got incredibly and painfully numb, and then it hurt while they were warming up.

I will see a doctor in the next few days, but I would very much appreciate your opinion on this as well. Thank you so much for your time!

Hi Lila,
Based on the fact that you are in a cold environment I would not at all be surprised if it is superficial frostbite, but you do need to see a doctor to get firsthand confirmation.
You do not want to run the risk of the skin breaking down and becoming infected.
Marc Mitnick DPM