severe pain bearing weight, pain moves to different areas of foot

by julia
(san luis obispo,ca usa)

In February,I was walking more than usual and I noticed one day my foot hurt. By the next day I was almost unable to bear weight on it. It started on top of foot, I loosened my shoes and pain continued to get worse. It moved over to my toe then to right side of my foot. I saw podiatrist who built up shoe to keep weight of area and that helped some. It is a mile in to where I work and constant walking. Xrays show nothing. Now I saw another podiatrist who has no idea but gave me cortisone shot where sureal nerve is very painful there. Then pain moved to my ankle another shot. Pain is now my second toe. I can move it pinch it twist it does not hurt, only when I walk is it unbearable. My foot is not warm, dr said swelling in capasule but not noticible. HELP, this is almost 3 months and is very painful. MRI shows bone marrow edema in various areas as well as edema in soft tissue. Again I have had no injury. The pain is a dull pain and foot feels heavy now.

RESPONSE

Hi Julia,

So, what I am gathering from your narrative is that you have diffuse pain in one foot which has moved to the ankle, then to the toe. This all occurred as the result of walking with no history of trauma.
I know nothing about your medical history such as your age, weight, overall activity level, do you suffer from any disease states like arthritis, lupus, rheumatoid arthritis, etc. I will assume you are otherwise healthy since none of this has been mentioned.
Bone marrow edema on the MRI represents stress areas to those affected bones where the edema shows up; soft tissue edema means there is inflammation going on. May I also assume no other parts of your body hurt?
If that is the case then according to your narrative we are down to pain in the second toe (it seems that the pains in the ankle are gone).
Generally the most common cause of pain in the second toe would be from a condition known as capsulitis, you can read about it via the navigation choices to your left. This is a stretching of the ligament on the bottom of the foot that connects the toe into the metatarsal bone behind it. With no history of trauma, this may have been caused by a flexible soled shoe which allows the toe to hyper-extend or over bend upwards and thus causes pain on the bottom of the toe. You mention that the last doctor talked about the capsule being swollen, but not noticeable. I do not know what that means. If it is swollen then its noticeable and would coincide with my suggestion of capsulitis.
That would be the most common cause of your pain which came about for no apparent reason. I would really need to examine you to come up with a definitive diagnosis.
If I were treating you, that would be the first thing I would look for. I would also examine your shoes because it is amazing how many foot problems are caused by poor fitting shoes. The fact that you have had pain in different portions of the same foot also leads me to believe your shoes may be a factor.
What is generally done in cases where the foot specialist cannot come up with a definitive diagnosis and there is pain secondary to inflammation, and is occurring in multiple areas is to put your foot in a walking boot for a period of time, perhaps as long as four weeks, or so, to give the inflammation time to calm down. In addition anti-inflammatory medication should also be of benefit, assuming you can tolerate that type of medicine.

Marc Mitnick DPM
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