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The response to the question below was authored by Marc Mitnick DPM
Pain base of 2nd toe
(Albany, NY, USA)
I'm 49. Over the past few years have occassionally experienced pain in the ball of my right foot while playing hard-court sports. Felt kind of like a bruise. It would generally go away on it's own with or without rest. 3 and 1/2 weeks ago, while coming to the end of a short sprint on a turf field, I took a long last stride and landed on my right foot. It was a normal landing with no usual twisting except that I felt a sharpish pain in the ball of my foot (around my 2nd toe).
Have continued being active presuming it would subside but it has steadily gotten worse to the point that walking directly on it is very painful. (I can walk on the rightish side of my foot without pain). By squeezing each joint between by thumb and index finger, I have found that the pain is isolated to the joint at the base of the 2nd toe (from a diagram of the foot bones, it is the joint between the Proximal phalanx and Second metatarsal). Applying finger pressure causes sharp but minimal pain. Having the weight of my body on it causes the most pain. In particular, going up on my toes is most painful to the point of being prohibitive. The pain feels more at the base/bottom of my foot than the top. There is swelling.
I just returned from an orthopedic surgeon who said there were no fractures on
the X-ray. He wants to do an MRI. He mentioned one possibility is a condition which he said particularly occurs at the head of this joint which I believe he
described as being a degenerative condition of the blood vessels. He gave it a
name which I believe had "syndrome" in it, but I cannot recall now.
The main purpose of this post is to try and find out what that "syndrome" might
be so that I can do some research. I would also be interested in any other
potential alternate diagnosis. I have confidence in this doctor and expect the
MRI to eventually yield the problem, just looking for more information so as to
be better informed.
One extra bit of background information which occurred to me is that my toes
(on both feet) have always felt a bit tight/inflexible. When stretched backwards, such as during a massage, the tendons always felt particulary tight
and uncomfortable. I wonder if the problem might be related to a badly strained
tendon or similar.
thanks in advance for any help/insight.
For anyone who treats foot problems on a regular basis, your thorough description of your symptoms is that of capsulitis . Had you not had an x-ray, I would have also considered a stress fracture, but since there is no fracture you are presenting with classic symptoms of capsulitis.
Your doctor is probably referring to Mortons syndrome which is basically a long second metatarsal bone relative to the first and third metatarsal which will cause pain exactly where you describe.
As far as I am concerned there is no need for an MRI right now. If the pain does not subside after it is treated as capsulitis, perhaps then an MRI.
Marc Mitnick DPM
Johns Hopkins Medicine
University of Rochester Medical Center
American Academy of Pediatrics
Penn State Medical Center
National Institutes of Health
Columbia University Department of Rehabilitation
Stanford Health Care
Illinois Bone and Joint Institute
Mount Sinai Hospital
Institute for Chronic Pain
University of Florida Health
American Family Physician
University of Maryland Medical Center