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The response to the question below was authored by Marc Mitnick DPM
Pain in Foot Pad
I have high arched foot (with bunions) foot tends to pronate in due to some turning in of feet pigeon toed tendancies. I was on my feet all last year on concrete working at a school. No problems other than typical aches. I wear flip flops regularly and 5 weeks ago was literally strolling when I started to feel a pulling sensation in between 1st and 2nd toe where strap is of shoe. It eventually got worse and within a week felt like I had a rock there. Went to Podiatrist and he took x-rays but said he did not see stress fracture and called it nerve inflammed/capsulitis. Had a cortisone shot to that area and ordered orthotics. It took up to one week after shot before I could even attempt to walk and then only in a padded soccer slide shoe. I then had to use callous pads the following week to pad under the foot pad area to being able to bear any weight. 3 weeks later I start to experience stronger pain in between the 2nd and 3rd toe area and go back for evaluation. There is an obvious lump that I can feel and cannot bear weight as it feels like I am stepping on a rock. He manipulates the area and it causes unbelievable pain. He feels that this is either a neuroma or a plantar plate tear. No MRI or further test is done, however he injects this area with Cortisone and places a metatarsalgia pad in the area. I am now one week out from this shot and still have
tenderness and swelling to foot pad area. It is swollen larger than the metatarsalgia pad so still makes it difficult to walk and feels bruised/tender to the entire area. If I step down towards the front on the foot pad it is like an electrical current or shock is going through the entire front of my foot. At this point I can only step by placing weight on heel or arch pad and it is causing stiffness and stress to my knee and hip joints. I am scheduled to leave the country in a couple of months for 6 months and will have no use of a vehicle and be required to walk everywhere...which at this point is impossible. Any advice/help would be greatly appreciated. I am not sure either why it takes so long after a cortisone shot with swelling on the pad, tenderness and bruising?
Capsulitis, nerve entrapment or plantar plate tear are certainly all possibilites which would lead me to consider ordering an MRI if my patient did not show favorable response to the cortisone injection.
Additionally, the problem with these types of injuries is that walking on them generally further irritates them, or at the very least slows down the healing process because every time you take a step, you are further injuring an injured area.
I would recommend an MRI to try and get a more definitive diagnosis. In addition, since time is not on your side, I would recommend considering a walking cast in an effort to "rest" the area. Speak to your doctor about these possibilities.
Marc Mitnick DPM
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