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Looking for help

Discussion in 'General Issues and Discussion Forum' started by evbain, Apr 8, 2005.

  1. evbain

    evbain Welcome New Poster

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    I'm not sure whether posting here is out of place - I hope I'm not intruding or upsetting anyone by doing so but I'm hoping that somebody out there might be able to help me.

    When I was about 18 (nearly 10 years ago) I started getting sharp pains in my feet after I did any kind of exercise. The pain would normally only last for a couple of minutes before subsiding. However it was painful and consistent enough for me to go to doctors about it. I was told it was various things including cramp and growing pains, and that it would probably disappear of its own accord.

    One day, about 4 years ago, the sharp pain happened again after exercising, only this time it didn't subside after a few minutes. It took 2 or 3 months to subside, and during this time walking was next to impossible because it was very painful. I had an ultrasound that was "inconclusive" and ended up seeing a podiatrist. He made me some orthotics which helped and my feet seemed to be improving.

    However 6 months ago my feet started getting more painful again, and now the sharp pains keep returning without me doing exercise. I have seen doctors on the National Health Service (UK) and felt let down. I have started seeing private consultants and feel equally let down. I don't feel taken seriously amd am beginning to doubt there's anyone out there who can help. I'm in constant pain now and starting to feel quite desperate.

    Basically, I don't know where else to turn and am at a loss as to what to do. If anyone is able to point me in the right direction I'd be very grateful.
  2. tommy

    tommy Welcome New Poster

    No one could diagnose the cause of your problems over the internet with any degree of certainty. A full history of your complaint and a full physical exam are the minimum requirments.
    You do say that orthotics helped for a while, have you returned to the podiatrist that gave you them ?
  3. footdoctor

    footdoctor Active Member

    foot pain help

    Dear sufferer,

    As Tommy has said, a detailed examination from a podiatrist is really what is necessary.But I will certainly try and help you if i can. I will need answers to the following questions.

    1) What is the exact location of the pain?

    2)How would you describe the pain i.e sharp,dull,etc?

    3)Did your problems occur after an injury,i.e twisting your ankle,dropping heavy weight on your foot

    4) Does the pain occur only after being on your feet?

    5) When does the pain occur i.e first thing in morning,during day,in bed at night?

    6)Did your foot orthotics completely help,and were there made from a prescription and plaster casts of your feet(custom made)

    If you could reply to these i'll get back to you with some more!

    Scott Shand-Podiatrist
  4. evbain

    evbain Welcome New Poster

    Thank you both for your responses. I will try to respond in turn as fully as I can.

    Firstly I would like to say that I was never trying to get diagnosed over the internet - I would feel far more comfortable if there were someone who could examine my feet with me being there anyway. I feel as though I have been passed from health care professional to health care professional, and each one just passes me on to another. Hence my question was more to find out if there were other people or organisations that I could turn to, rather than diagnosis. I apologise if this was unclear.

    I have returned (many times) to the podiatrist that gave me the orthotics. Multiple adjustments were made and it was about 6 months ago that he said he didn't think there was any more he could do, and suggested I see an orthopaedic surgeon.

    In response to your questions, Scott:

    1) The pain started about 10 years ago in the base of my toes, normally between the third and fourth toe on both feet, sometimes between the second and third toes. It felt a bit like cramp and a doctor at the time told me to eat more bananas. Different pains have now developed in different regions - I now have arch pain, and a "stiffness" at the base of my big toes. I also sometimes get lesser pains near the top of my feet.

    2) The pain at the base of my toes started off as very sharp and sudden, and would disappear after a few minutes after massaging. It was quite annoying that it occurred after exercise, because I used to love badminton, swimming etc, but it wasn't to the point where it affected my life in the way that it's doing now. About 4 years ago this sharp sudden pain happened again, but didn't go away after a few minutes. It subsided to an ache that lasted for 2-3 months, which felt like there was a stone in each shoe at the base of my toes that I couldn't get rid of. It was this pain that the orthotics helped with, but it still hasn't subsided completely. I have tried doing a little sport since then, but the sharp pains usually come back (even with swimming). I can usually feel a tingling feeling just before this happens.

    3) If there was an event that caused injury ten years ago, it wasn't a memorable one. What I remember is cycling to school and every now and again getting sharp pains in my feet which meant I had to stop. The pains got more and more frequent and more and more painful until I saw a doctor about it because it was happening nearly every day. As for four years ago, it was about September / October time when I took up playing squash, and February when my feet had that sharp pain from which they didn't appear to recover. As for an "event" - again if one happened it wasn't memorable.

    4) The pain used to only occur after or during exercise. This didn't have to be being on my feet - it happened quite frequently when I was swimming too. However these days the sharp pain appears to be a bit random. It seems to occur any time, any place, and can be really inconvenient. Things I have noticed that make it more likely to occur include exercise (still) and sleeping with a duvet on my feet (they don't like being squashed too much so I have to wear socks and leave them hanging out of the bed). On the same grounds I have to wear sandals all the time (even in winter, which has given me chilblains) because they're the only things that won't squash my feet to the point that the sharp pain returns. They also seem to be really sensitive to temperature (both hot and cold). Having said all that, sometimes it is completely random, and despite leaving my feet outside the bed they have been known to wake me up with sharp pain in the middle of the night.

    5) As in (4), there are certain things that make it worse, but generally it happens randomly. Very embarrassing if I'm trying to walk round a supermarket or driving or something. I'm starting to not leave the house in case I get stuck somewhere because the sharp pain doesn't go away.

    6) The orthotics were custom made from a plaster cast by the podiatrist I was seeing. He tried to alter them specifically for my needs when I was still in pain. They have helped a lot, but not enough to take away the pain. Wearing my orthotics I can stand up "comfortably" for about an hour. Without then I sometimes (not always) have trouble standing up long enough to take a shower (so I generally have baths). After that the dull ache that feels like a stone gets worse, and sometimes the tingling starts. So I would say yes they have helped, but not "completely."

    I have some other information that may or may not be helpful. The podiatrist told me that the likely cause of the pains in my arches was a tight Achilles tendon and gave me exercises to do to try to lengthen it. I had an MRI scan done before Christmas. The orthopaedic surgeon I saw in December tried to interpret the results for me, but said it wasn't conclusive and sent the scans to another doctor in the end. If I remember correctly he found potential evidence of neuromas, excess fluid in the base of my big toes, damaged cartilage and gangrene. However he wasn't sure about any of it because he said he dealt with bones. The doctor they are with now has been promising me an ultrasound since January and still hasn't interpreted the results. He's also messed up so many other things that I've got to the point where I don't trust him - hence the post on here - I'd like to find someone I can trust to interpret the results and help me with the next step.

    Thank you both again for taking the time to read and respond to my message.

  5. C Bain

    C Bain Active Member

    Looking for help!

    Hi Evelyn,

    Tried to send a posting, Noon today, got to the end with last modification of a sentence, vanished without trace? Somebody must be having some interesting reading!

    Second attempt:- You are right not to be seeking diagnosis over the INTERNET, Crystal Ball Gazing I think?

    I fear it's pillar to post time again, (You must not give up!). However, you must go back to your G.P. and ask for another consultation, (May need to be private first and treatment by the NHS. later?), I don't know where you live, I assume it's U.K.? (Don't write it here! Hopefully with a successful conclusion!). I could suggest a neurologist regarding your symptoms but you are not to trust anyone, including me regarding possible diagnosis including poor circulation, etc.???

    It should go as a rerun of G.P. - Consultant - Diagnosis - Treatment!

    Your a bit young for 'Intermittent Claudication' and Quinine tablets? Blood and urine samples etc. to check for Diabetes, Thyroid, Gout and a host of other things can be done by your doctors nursing staff if they have not been done already!!!

    It maybe wise to stop the energetic activities until you have some satisfaction regarding treatment, you could be aggravating it by the exercise? (Ask your doctor?).

    Gangrene? You must get urgent answers about this from all your medical practitioners???

    Straight into see your G.P. and see if you can get a re-examination of where you are at from him!!!


    Colin. (Bain, you are not in Scotland, by any chance? NHS. may have different procedures up there if you are?).
    Last edited: Apr 10, 2005
  6. footdoctor

    footdoctor Active Member

    g.p or podiatrist?

    Colin, do you really think that a G.P will be able to diagnose such a problem?Surely a good podiatrist will be able to diagnose the problem and either treat or refer appropriately?
  7. C Bain

    C Bain Active Member

    Looking for help?

    Hi Footdoctor,

    Yes in this case I really think I do, (Referral to doctor again I mean!). Sounds like Evelyn has already had a good podiatrist try and has had to give up on the problem? This problem doesn't sound like something that should be attempted, (Diagnosis I mean.), here! Let her G.P. refer back to a podiatry Centre in their local hospital if that is his judgment? Furthermore, this Forum is not equipped or designed to deal with Evelyn's problem, (In my opinion of course, and in the spirit of this Forum I hope!), as she has already sensed I believe?


  8. evbain

    evbain Welcome New Poster

    In my opinion I'm not sure a GP is a good next step for me, just because I've been to so many, and they all seem to be very "general" (I guess by their very nature) and tend to refer me on to the local "specialist". Therefore I suspect any local GP I go to will refer me back to the first surgeon I saw four years ago because it sounds like he's the first port of call in this area. I decided to go private because my first dealings with him were unsuccessful (to say the least).

    I know that if I go to the GP I'm going to feel like I'm starting the whole process again.

    Colin - I have tried to get blood tests from my GP to rule out many of the things you've suggested on the advice of my podiatrist, but I got the impression the GP didn't like being "told what to do" by a podiatrist and refused to give them to me.

    The podiatrist I went to was really sympathetic and great, but in the end told me that he could only really deal with mechanical issues and mine seemed not to able to be completely solved that way in his opinion. Hence I went privately to an orthopaedic surgeon (although I also went to one of these on the NHS before the podiatrist too, who was the one mentioned above). The latest one gave me the MRI and passed me onto the new surgeon who's messed me around so much I don't know where to go.

    Basically I'm trying to find someone that will take me seriously and is in a position where they can help or knows where to refer me. I figure there must be someone out there who knows the right place to send me, hence my attempt to try and get opinions from a different audience via this forum rather than confining myself to the local health system (which so far hasn't got me where I want to be).

    Once again, thanks both for taking an interest.

    P.S. Colin - Scottish by birth but now living in England!

  9. W J Liggins

    W J Liggins Well-Known Member

    Hello Evelyn

    I concur with the answers given by my colleagues. However, it does seem that you may have more than one presenting pathology. I strongly urge you to seek an opinion from a podiatric surgeon but most, (if not all) practitioners will require a referral from your G.P. even if you seek private treatment. I suggest that you take along all the scans and reports on your condition.
    I am sorry that you have lost confidence in your previous practitioners including your G.P. If you really feel so strongly, you might wish to consider a transfer.
    I echo the previous posting. If you have evidence of gangrene, then you MUST seek help now.

    W J Liggins
  10. Sure sounds like you have Morton's neuroma. Ten years worth of gangrene should be diagnosable by now by the family dog or a three year old nephew.

    Neuromas are accumulations of scar tissue about the nerve sheath. Often they arise spontaneously between the metatarsal heads at the bases of the toes, and as they aggrandize with scar tissue, they become more intensely and frequently symptomatic, to ever-slightening pressure.

    Do you have wide feet, or have you had difficulty in the past with shoe fitting? Do you prefer sandals to closed shoes when the weather allows?

    Did anyone who read your ultrasound or MRI admit to you that these scans are very difficult to read, let alone affirm a diagnosis at the forefoot, even in the hands of experienced practitioners?

    You should again try to contact experienced foot people, preferably ones who have successful surgical track records, and good reputations, in the dance community. Ballerinas are susceptible to neuromas due to the constrictions of pointe shoes about usually very wide feet. Visit the surgeon for the Royal Ballet. I'd be shocked if he/she couldn't diagnose your problem within minutes

    Ask the practitioner if he/she has ever heard of the Mulder's test, and can she/he perform it. This is the clinical test for Morton's neuroma and I'd wager, correctly performed would have a near zero-% false negative rate in someone whose neuroma(s) have been accreting over an the span of a decade.

    BTW, the standing in the shower pain, now lessened since you started the orthoses, which haven't helped completely, throws me off a bit, unless...you are forced to wear bigger shoes when wearing the orthoses, and the bigger shoes per se give your neuroma breathing room. Also, is it in both feet (yet)? I'd think the opposite foot would have joined the club by now.

    Keep me posted of your status.

    All best,

    Last edited: May 2, 2005
  11. dawesy

    dawesy Member

    Hi all, i agree diagnosis via internet is a bit sus, but hey its an interesting topic!

    TMN, certainly sounds mortons neuroma to me also from a distance. I concur its not those 'textbook' symptoms but if everything in feet was so straight forward, i don't think websites like this would exist!!!

    Away from the fact that this sounds like a mortons neuroma, i have similar sypmtoms myself (not to the same extent) in my right foot. I was borm with TEV (clubfoot) and walk with a pronounced low gear push off, so much so i do not bear weight much at all under my first MPJ. This burning is sometimes extremely bad, and can come about simply by standing in the wrong position. The best treatment for me has be a poron met dome on my orthotic which splays the metatarsals and takes some weight proximal to the heads. Not 100% but keeps me going.

    The other thing i would be keen to know has Evelyn had a Hx of back pain? Im aware radicular pain is often postural and positional, as well as being rare to just being in the foot, but not long ago i had an interesting case. (sorry if bit off thread). Middle age lady, buring pain medial aspect distal phalanx left hallux. No obvious gait abnormalities (slightly xs pro, abductory twist... all minor degrees), and not painful on palpation. No difference shod/unshod. Attempted all sorts of padding and massage. Xrays -ve, no history of any health problems (eg vascular, diabetes), only ongoing LBP. This had been increasingly worse and had not been seeing chiro for a while, so we discussed returning for some therapy.

    3 months on no pain in the toe whatsoever. Could be co-incidence (even placebo??), nothing else in life was changed. Her back pain improved and so did the burning pain in her toe.

    Nerves truly are perplexing. :p

  12. Kevin Dow

    Kevin Dow Welcome New Poster

    I agree with the last two posts!

    It seems to me that anytime there is some type of nerve pain localized to the third interspace with distal manifestations, I'm thinking Neuroma until proven otherwise. There are some important issues you mentioned, one of them was your activity leval and the other one was the Equinus. Both of these could be contributory factors for a nerve compression. Just a suggestion but has anyone considered a nerve block with some local? Pain goes away... Bingo!
  13. evbain

    evbain Welcome New Poster

    Thanks again to everybody who has showed an interest in this. I really appreciate such a wide range of opinions.

    Thomas, I'd like to try to answer some of your points if I can! I do prefer sandals to closed shoes. I don't like closed shoes so much (because of the pain) that I have been wearing sandals all winter which gave me chilblains. That's the extent of my fondness for them!

    The people that interpreted the MRI scans and the ultrasound scans both admitted that the scans were difficult to read. I have finally had an ultrasound a few days ago (although it's taken months to happen!) and they told me it looked like neuromas and bursitis. This was also backed up by a podiatrist who performed Mulder's test, which was positive for neuromas (but he said it was located between the 3rd and 4th toe, the ultrasound showed (apparently) it was between 2nd and 3rd). They're going to try steroid injections - does anybody know much about these?

    I might investigate the ballet route for more information - it's a good suggestion and something I hadn't considered. Thanks!

    To answer the question of whether it's in both feet - it is and has been for years. I'm afraid I don't understand some of the more technical speak - Kevin, what's an Equinus?

    The surgeon I spoke to said that if the steroid injections were successful, the pain was likely to return after a few months and that they might consider an operation. Again, if anyone has more information on what this might involve (eg what exactly this would involve, what the success rate is, and whether I can increase those chances) I would be grateful.

  14. GarethNZ

    GarethNZ Active Member

    A steroid injection is a high concentration anti-inflammatory (for one of a better term) that tends to reduce the discomfort in the webspace where the symptoms are coming from.

    In some cases there will be fluid (inflammation)in the bursa (a bursa is a fluid filled sac that sits between the metatarsal heads - if this gets irritated it tends to gets inflammed and increases insize slightly). Having this done under ultrasound guidance is the best way to ensure that the medicine is getting as close to the problem as possible. If it is the bursa that is creating most of the symptoms then this can be helped by draining fluid from it

    Good luck with everything!

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