Hi Neil
I would greatly appreciate your advice as so far I have had four conflicting
diagnosis from doctors here and really don't know what to do.
I had started increasing running earlier this year and in April started
having a lot of pain in my left foot - mainly in the joint of the toe next
to the big toe. The Dr. said it was either a stress fracture or a pinched
nerve (Morton's toe). I had xrays and a scan which he said showed a stress
fracture. I rested for about a month but there was no improvement. I then
was about to put it in plaster for six weeks when the second Dr. who was to do
this said it was not a stress fracture and that I should continue to take
it easy.
Still no improvement and frustration begins so I went to another Dr. who
said it was a pinched nerve. She gave a few injections which did not help
and said I could have surgery to have the nerve cut. I have read up on
Morton's toe and this seemed a solution. When I went to make an appointment
with the surgeon, she said it was not the nerve but there was a small pad
beneath the second metatarsal which was ruptured beyond repair and the only
thing I could do was wear insoles - which would not solve the problem - just
ease the pain - or have an operation to break the second toe, raise it and
put in a pin!
I had a bunion operation about 15 years ago so my big toe is smaller than
the second - where the problem generally is.
I feel from all of the options that it could still be the nerve. My
question is, when I do spend more time on my feet, there is swelling - would
this happen if it was the nerve?
Also, is it possible to have permanent damage to this small bone/pad which I
understand is under the joint, similar to the knee pad in the knee, if that
in fact is the problem?
I would very much appreciate your help as I have no idea where to go next.
I haven't been running for four months but have no improvement.
Tough problem Susan!
Usually, when a bone scan shows a stress fracture, it is a stress fracture. Buta
fter a few weeks of reduced weight bearing, it shoud begin to heal. Since you
have no change, you have to consider theother two options. Mortons neuroma vs a
sesamoiditis (the sesamoids are the little tendon bound bones that live under
the big toe. If your toe is not very flexible, the sesamoids take a beating, and
get very inflamed. But if the nerve were inflamed, then an anaesthetic
injection into the nerve should give you instant relief. If that were true, the
mortons neuroma surgery would make sense. Since you had no relief with surgery,
you have to treat the sesamoids.
As far as your treatment options are concerned, try really hard to avoid
surgery. Make your surgical choice the last option since surgery is not
reversable. Try a varety of orthotic solutions first. Get an orhotic that is
posted into the forefoot with a first ray cut out, but have them refill the cut
out with poron. Experiment with this sort of thing quite a bit before giving in
to reconstructive surgery.
..
..
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