Severe foot pain and swelling

by Dan
(Hayward, Ca)

I'm a 62 year old male. I've always been active and in good health until 5 years ago when I got DVT in the portal vein of my small intestine. They removed 11 ft of my small intestine. After recovery, I returned to a active lifestyle, playing drums and singing in a cover band. About a year ago, after the band finished our show, I noticed pain and edema in my right foot. The pain passed but I continue to have edema. The foot pain returned along with numbness in the pad nearest my toes. When I woke in the morning, the bottom of my foot started burning and the muscles clenched making walking nearly impossible . Ibuprofen helped take the pain away, but never completely. I've rested and elevated the foot, along with icing but there hasn't been any improvement. It seems like the pain is getting worse. The whole bottom of my foot hurts now. If I don't take ibuprofen, I can't walk and the pain is so bad, I feel nauseated. I had X-rays done and there aren't any fractures. Just a little inflammation and small spur near my big toe

Thanks
Dan

RESPONSE

Hi Dan,

Quite honestly your problem appears to be too complicated for me to really answer without being able to examine you, but I thought I would comment anyway because I am not sure your doctor is moving in the right direction.

Yes, there is always the possibility that you suffered a stress fracture of your foot and that can occur without any history of trauma and yes that would cause pain and swelling in your foot, at least swelling to some extent, but it sounds to me that you are having more than just a little swelling.

What bothers me is that this has been going on for a year and the fact that your x-ray failed to show any history of a current or healed fracture leads me to believe that your doctor should further explore other possibilities.

The next most common problem might be some sort of arthritic flare up in your foot, not so much osteoarthritis which is normal "wear and tear arthritis" but perhaps something a bit more esoteric, that would require blood work, to rule out things like gout, rheumatoid arthritis, Reiter's disease and other not so common arthritic conditions.

Now, here is the reason I bothered to respond to your question. You have a history of DVT in your intestine. People who develop DVT have a propensity to develop it again either in the same place (not your case) or anywhere else in the body.

DVT can be caused by a number of situations including trauma, sluggish blood flow in general, thickened blood and narrowing of veins. My point here is that with a history of DVT, this has to be ruled out as the source of your foot pain and swelling.

I have had a couple of cases, over the years, of people who presented to my office complaining of pain and swelling (usually excessive swelling) in the foot that turned out to be DVT. This is in contrast to most people who experience DVT in the calf.

Because DVT can have serious consequences if not treated, I would think it would be wise to bring the issue up with your doctor and perhaps consult with a vascular specialist.

I am not saying this is your problem, but with your medical history this possibility should be ruled out.

Marc Mitnick DPM
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