Sporadic pain at base of second toe

by Linda
(Belmont, CA, USA)

I am a 47-year-old woman. I do not wear high heals because I have a history of intermittent back pain. I wear prescription orthotics and usually wear very comfortable good shoes that give my toes plenty of wiggle room.

A few years ago, totally out of the blue, the second toe on my left foot began hurting. I remember feeling tremendous pain in my sleep one night, and upon waking found that my toe was killing me -- as if someone had hammered on it overnight!

I went to my podiatrist. She took an x-ray but found nothing wrong. We thought perhaps I had Raynaud's syndrome, because a few days previous to the pain my toes had been very cold and had turned blue. (I had been outside in sandals at night and it was colder than I'd expected -- my feet had been freezing cold). I went to a specialist who ruled out Raynaud's. She said that the pain would have happened immediately after my toes turning blue...not several days later.

The pain disappeared in about a week and didn't come back until about a year later. At that time, I thought perhaps those particular pair of sandals (which have a 1 1/2 inch heel -- and which I was wearing the night my toes turned blue) were causing the problem. Perhaps they were putting too much pressure on that area of my foot. So I decided not to wear the sandals anymore. I went back to my podiatrist, and this time she said perhaps I have a nerouma.

My foot was fine for over a year, and then again it appeared out of the blue. But this time I was not wearing any sandals or "bad" shoes. I was wearing good shoes I'd been wearing for months, with my RX orthotic! Upon closer manual investigation and palpitation of my toe, I realized that the toe itself wasn't hurting -- it was the area directly beneath the second toe (where the toe "attaches" to the ball of the foot). When I press in on that area, it is painful.

Lately the pain keeps coming and going, but for no discernable reason. Last night I felt it building up as I slept, and when I awoke sure enough it was so painful I had to limp. I've taken strong RX NSAID anti-inflammatories today but they didn't seem to touch the pain.

In your opinion, what is going on with my toe/foot? Is it Morton's Neruoma, Capsulitis, or something entirely different like a pinched nerve somewhere else? My second toe IS longer than my great toe, but not by much...certainly not as much as photos I've seen of other people's toes with Morton's.

Visually the toe appears totally normal, not swollen or bruised or anything. I don't have any abnormalities on my feet such as bunions or hammertoes or anything like that. My toe nails have always been rather brittle, but I doubt that has anything to do with this, either.

I would greatly appreciate your opinion. Thank you!

Hi Linda,
Initially, upon reading your story my first thought was a gout attack, but you are kind of young for that (as a female), and upon finishing your story it sounds like you may have capsulitis.
Here is why I like gout:
1. Occurs for no apparent reason
2. many times will occur at night
3. pain will be excruciating; may not respond to medication.
4. pain will be present for a period of time and then disappear

Here is why I like capsulitis:
1. usually will be the result of wearing a certain shoe or performing a certain activity; remove either contributing factor and the pain should subside.
2. the area you "pointed" to is exactly where capsulitis occurs.

So...based on your story I am getting mixed signals. So what can you do? You might ask your doctor to rule out gout. One way would be to take colchicine the next time you have an attack; it is specific for gout, if it helps then you had a gout attack, if no help, then no gout.
Does your prescription orthotics have a metatarsal pad built into it and is it thick enough? If you are having capsulitis then the metatarsal pad should be very beneficial.
Unfortunately because I do not have the luxury of examining you, that is the best I can do based on your description of the problem.
Good luck.
Marc Mitnick DPM