Right foot fore foot near fifth metatarsal pain

by Lizz
(Largo, FL, USA)

((I apologize that this will be very long but I want to give you as much detail as I can remember or give))

Background information:

About seven years ago while in Basic I was assisting with a detail and happened to fall forward causing my foot to bend upwards. (Think of it this way: holding your hand out with the top part -your fingers flat- and pulling the palm upwards toward the fingers as if trying to crack your knuckles). For about three or four days I walked on my foot as well as possible, I ran a couple of those days, I was also walking up and down stairs at least six times a day if not more, I also did it again (bending foot) while getting dressed I believe two days later -my foot was on one of the posts to a bed and it slipped off the post-. After I finally went to get it looked out, and after only Xrays I was medically discharged with "Plantar Faciitis". The VA even wrote it as "Platar Faciitis". My foot only really starts to hurt when I have been standing in one spot for a long time (like standing at a cash register or in a line for something). It does not normally hurt when I get up for the first time, nor do I have any kind of heel pain. When it happened my pain was at the arch of my foot and all along towards the big toe sometimes graduating towards my leg, at the calf, but rarely. I do not wear high heels, they hurt. (While in basic I still wore the heavy combat boots most of the time, about a month before I left was I allowed to stay on the sneakers we wore). Also, roughly a week or so after I came home we visited some friends, where the most strenuous thing was riding a bike up and down the neighborhood. A few days later I noticed that, oddly, my ankle hurt. To the touch. I never fell, to my knowledge I never twisted my ankle, nothing. I went to an urgent care doctor who only took Xrays but decided to put my foot in one of the plastic boots and give me crutches ((while in basic I had a metal boot and crutches for a short time)). He also said that if it didn't get better after I think two or three weeks that he was do an MRI or CAT scan. This lasted maybe a week and a half and got better so I never went back.

Now:

Almost a year ago I had this strange sharp pain. I was walking with friends at an amusement park, we'd probably been there roughly two or three hours when all of a sudden I got this odd, searing pain in my foot. Like someone picked up a cattle prod and shoved it inside my foot right where that little 'ball' right under the pinky toe is. And not in the normal spot (normal to me anyways). This time it was on the opposite side of my foot just below the littlest toe and just below that part that rounds before you get to your arch. It happened maybe two more times while I was at the park and then it would happen intermediately for about a week. Then it just goes away. It comes and goes and I never know when it will or what exactly makes it come. I think (but cannot say for sure) that if I overuse my foot for anything a day or two before it sometimes aggravates it. But it does normally go away within a few days.
The worst one I've had so far is just the other day (Sunday 3/18/2012) The only thing I can think of that could have helped it along the way is over doing it at work a couple days previous. Saturday and into the night I was fine, (I work third shift). Sunday (3/18/2012) morning and into the afternoon I was fine. It wasn't until I got up Sunday night to get ready for work. I went to take a step like I normally do and this bad, searing, almost like a shock in the inside of your foot, just reached out and zapped me. I gasped, like I normally do, waited a second to see what would happen, then continued on (this time limping a little to try to keep it from happening again).
In the time it took me to get ready and take my shower (roughly 30 minutes) the same thing happened three or four times. It happened again while I was driving to work, if I remember correctly it was either switching from the gas petal to the break or just pressing the gas petal - I really don't remember. While I was at work (a nine hr work day with two 15 min breaks and one hour lunch) In one hour it happened twice (I was walking the whole hour). But it also happened while I was standing still, and one time while I was sitting down on a break. It's slowly calming down I think, but again it's hard to tell at times, and right now I can just, feel something. My toes are also tingling and kind of numb but I do feel it if I poke my toes with my nails or if I try to tickle my foot I do feel that also. ((Also, I know that if someone where to push down on my big toe I cannot push back up with my big toe -not sure with the other toes- but I can push a hand with my foot, they tried that at the VA))
And I don't know if this connects at all, but a few days later (3/21/2012) I went to get up and I fell. My whole right leg and foot just gave out under me, I don't remember it feeling like anything was asleep, but I had, myself, just gotten up from being asleep. I think that's about it. Right now, 3/25/2012, it hurts mainly like a dull throbbing or a sharp ache, and it hurts to drive but not too much that I can't drive as long as it's a short distance. It also hurts if I happen to lay that side of my foot against something hard, like pressing that side of my foot against a mattress. It does not hurt to the touch, but extreme pressure does allow for a slight gasp or 'ow'. I would think on the lines of a pain scale somewhere between 3 and 7. The three at normal rest and the seven at times that it just hits me whether I'm walking, standing or sitting.
Also at times it just feels like there's *something* there, sometimes it feels like there's something moving around in my foot, but not always.

And if it helps if I was looking at the foot anatomy correctly my biggest guess of where this is is: (again this is just a slightly educated guess) either at the very top of the fifth metatarsal or the very bottom of the fifth proximal phalanges.
While touching/putting preasure to my foot to make sure I had the correct parts and the correct bones I touched the top of my foot near the fourth and fifth metatarsal and had a dull pain, then another one when I touched the bottom on my foot near the middle -give or take- of the fifth metatarsal.
I cannot tell if it's swollen. I don't believe so, but I am very bad at deciding whether something is or not if it isn't completely obvious.
I did try to wrap my foot with an ace bandage for a few days, but I stopped because the feeling of the bandage wrapped was hurting my foot at the same place.

Also: I work on a hard service, I am a night supervisor so I walk a lot, I also bend to pick up boxes often times heavy boxes, I turn and move a lot, as well as climbing up and down ladders at times.
The most strenuous thing I did before my foot started bothering me again was throwing freight quickly roughly two or three night previous, but again I was fine until that sunday night.

I normally walk around barefoot or with just socks. Other than that I wear shoes I bought at Payless (fairly comfortable and before that shoes with less support but I had bought store insoles that helped. It was wearing the newer shoes that it started hurting again -changing to the previous shoes did not help-. The first time of the hurt was with sandals, Earth Spirit sandals that actually give a decent amount of support. But it had been nearly at least three or four months since the last pain and this time. This time it's been nearly two weeks but it does seem, it may be slowly going away but I am afraid that it will come back like it did this time.
I do not wear high heels of any kind, nor do I wear pinched, narrow fore parts of shoes, like in a high heel. And I also cannot wear those 'walking shoes' they would hurt.

Thank you.

RESPONSE

Hi Lizz,

That is some story!! Anyway, I am not so sure the military stuff has anything to do with your present complaint as they appear to have occurred in two different portions of your foot and a period of time passed where you did not have any pain.
So dealing with the present situation, your problem sounds highly suggestive of either a Morton's neuroma which is a pinched nerve that occurs between the metatarsal heads. The nerve gets pinched at that area for a variety of reasons and then will cause pain in that area, but the pain can also travel into the toes and manifest itself as either frank pain, or at times, numbness, tingling and burning (all neurological type pain). The pain from a neuroma may on occasion travel up the foot as well but that does not occur so commonly.
In severe cases, the pain will be described as someone stabbing their foot with a knife. I have had patients over the years, in tears, from the pain. In the column to the left, read my section on "Morton's neuroma".
The second possibility might be that of a sub metatarsal bursitis, in your case probably occurring either under the fifth metatarsal bone head or possibly in between the fourth and fifth metatarsal head. This would give symptoms similar to that of a neuroma.
Let me state the obvious when I say to you that if your foot hurts as much as it does, particularly if the pain is not subsiding, meaning either in intensity or occurrence, then it might be time to see a foot specialist.
Both conditions I mentioned are treatable. If left alone your symptoms may eventually subside, but there is always the chance that the problem could also worsen.

Marc Mitnick DPM
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