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I have a 67 year old male patient who came in complaining of "spongy feeling on the balls of my feet". He has had this for 2 years now. It is in no way painful, it is "just an uncomfortable feeling". It is worse on rise in the mornings but is noticeable in some form all day every day, with or without footwear. Recent test for diabetes negative. Nil medications. He is 167cm and obese at 120kg. Examination of both feet was unremarkable. Neuro and vascular assessments WNL. Can anyone please throw me some ideas here? Thanks in advance.

 

HE is 67 and obese and no meds for HTN or Cholesterol? Does he see a Doctor regularly?

I assume he has tried supportive treatment with new shoes and over the counter orthotics. 2 years is a long time to have suffered with this.

In my experience, a patient can have a fairly normal neurological exam and still may suffer from Neuropathy with the symptoms you have described. Does the patient have a history of Chemotherapy, Alcohol Abuse. I suggest doing a Nerve Biopsy in the office to see if he has Small Fiber Neuropathy. These are very easy to do. In the States we have labs that will supply the kits and we mail directly back to the lab. Therapath and Bako are 2 of the labs we use. Metanx is a fantastic Medication that treats Small Fiber Neuropathy by increasing the epidermal nerve fiber density. However, it takes many months to work.

Hope this may help.

Dr Neil Snyder

 

Definitely no meds. I've triple checked. I was secretly hoping he was taking statins which may have helped with the diagnosis. Alcohol consumption moderate.

You mention new shoes and OTS orthotics. What is that aimed at in relation to the spongy sensation? I'm reluctant to go down this path before I have a clearer idea what is in fact causing this sensation.

 

The original description really smelled like peripheral neuropathy. Many paitent's with neuropathy will make similar statements. Could be early neuropathy. If you are pretty sure that it's not neuropathy, you have to choose the next highest probability on the differential diagnosis list. That next choice may be high forefoot pressures that you would treat with new shoes and off the shelf orthotics. You could call it a diagnostic orthotic and if worked for the treatment then you've killed two birds with one stone.

From what you've said so far, I don't have anything else to add to the differential diagnosis list. Keep looking

Eric

 

A 'spongy' sensation in the 'balls' of his feet ( I assume you mean the plantar 1st MTPJ region?) is a common description I hear for low grade sesamoiditis. Slight joint effusion from inflamed sesamoids will create a swollen, 'spongy' sensation in this area.

Physically palpate each of the sesamoids for any point tenderness. Evaluate further with imaging if indicated.

LL