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redness, swelling and pain below third toe

by Susan
(Cleveland)

Hello Doctor. Thank you for providing this helpful site. I've been searching for answers. I'm a 49 yr.old female. Five days ago (Monday) I noticed pain in the top of my left foot beneath the third toe while I was out shopping. I had not done anything stressful that day. Two days prior (Fri and Sat), I had worked in sock feet on a concrete floor for two days in a row. I don't remember any pain at the time. The day following those two days (Sun), I was resting off my feet for most of the day. (I'm currently undergoing radiation treatments for breast cancer on the left side). I showed my foot to the Oncologist on Tuesday (it's swollen on the top near the toes and has a red area, about 2"x3" near the toes). It's painful to walk and aches sometimes when I'm sitting. They wanted to rule out a blood clot, so I had an ultrasound and it was negative. They told me to take it to my family doctor. I have an appt. for Monday. About 14 months ago I stubbed my third toe, could this just be an aggravation of this old injury? It hurts to bend my toes forward or backward together, but you can wiggle each toe back and forth with no pain. No swelling in toes. Last night I took a couple of Advil and used an ice pack and that allowed me to sleep.

Thank you,
Susan

RESPONSE

Hi Susan,

While I was reading your narrative the first thing that came to mind was a stress fracture. These can occur without any real history of trauma. In most cases it can happen from just everyday activity and that is why people are surprised to find out they broke their foot when there was no history of trauma to the foot.
The next most probable diagnosis would be tendonitis or inflammation of the tendons on top of the foot. These are the tendons that allow you to bend your toes upward.
Again, there does not have to be a history of trauma. It is usually a result from overuse.
Another possibility, based on where your pain is located is an inflammation of the joint that attaches the second toe to the metatarsal bone. An example would be something simple as an arthritic flare up.
So, how do you know which condition it is? The first thing I would suggest is not to bother with your family doctor; this is not their area of expertise. Instead, I would suggest you consult with a foot specialist who is better equipped to narrow down the options.
The first thing you need is an x-ray to rule out a stress fracture, keeping in mind that sometimes very small fractures do not always show up on an initial x-ray, so the x-ray may have to be repeated a week later or your doctor might consider a bone scan.
An x-ray may also show the condition of the second metatarsal phalangeal joint to see if there are any signs of arthritis within the joint.
If, the x-ray is negative for both the above mentions problems, then you are probably suffering from tendonitis.
Whatever the diagnosis, a foot specialist will be able to give you guidance on the best way to treat it.

Marc Mitnick DPM
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