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572651 tn?1531002957

OT - Mystery Diagnosis for my Foot

We haven’t had a good old mystery diagnosis lately so I thought I would offer up my case history and get your feedback.  This is not MS related because it is not a CN problem  

Pt history:
Left foot Bunionectomy April 2012
Pulmonary embolism August 2012
Hammer toe – left foot developed 2013

Sx (that’s for symptoms and not sex)-

Pain in left foot – got orthotics for relief from hammertoe – helped temporarily but then started to worsen over  past six months.  
Pain worse over the past month or so.
Difficulty/impossible to push to standing position without using arms of chair or whatever I could grab to get up.  Positioned walker in restroom so I could get off the toilet.  Left leg would not push – has since resolved and standing from sitting position no longer a problem
Sharp pain in left calf, since resolved, but sent for ultrasound in February 2014 to rule out blood clot.  Negative for DVT
Swelling in left ankle & foot after prolonged sitting, began to happen more frequently the past six weeks
Pain increased in intensity in left foot  - swollen foot, primarily across the top at the base of the toes (mainly 2nd & 3rd metatarsal bones)
Foot NOT hot to touch
Foot NOT red or inflamed
Painful to touch swollen area, rest of foot does not hurt
NOT Painful while sitting or sleeping.  
Only hurts while standing and bearing weight (like walking)

Tests I have had so far:
Blood work – CBC normal, no infection
Bloodwork – uric acid in normal range,  not likely to be gout
Xray – negative
CT Scan – negative
MRI is scheduled for Friday.
Currently wearing a compression sock and one of those sexy post-surgery black boots to immobilize the foot

So is there a Dr. House in the crowd who might venture a guess?   I am stumped and so is the podiatrist  for now.   If you have any ideas, I would love to hear them.  And you can send me the bill for the house call.

Of course i will let you know if/when I get an answer... I see the dr again on Monday

26 Responses
Avatar universal
Okay, here's my fearless assessment, offered as one who lives with--in the words of my old PCP--Crappy Feet Syndrome. I suspect your bunionectomy was somehow botched. A millimeter here, a millimeter there, and the whole balance of your foot and leg are thrown off.

It's amazing how such tiny deviations can snowball into almost life-changing problems. Because A and B have now been shifted ever so slightly, you may be putting more weight on C during certain movements, which strains D, which then compensates by pushing closer to F, and on it goes.

I had a double bunionectomy by age 40, so already had developed the crappy feet well before then. Fast forward quite a lot of years with no particular problems, and then began experiencing pain in my left foot that ultimately had me walking more on the outside edge of the foot, which then too became painful. It was determined that the main joint in the big toe had developed hallux limitus. All that means is that it couldn't move up and down properly because of bony deposits.

So then a podiatrist decides this should be corrected by surgery that slightly shortened the first metatarsal. Right in theory, maybe, but wrong in practice. In short, he took a millimeter too much out. So then my weight shifted ever so slightly when walking, eventually causing a huge and painful callus on the ball of that foot.

Exit podiatrist. He'd had his chance and blown it big time, costing me weeks in a cast and a major if temporary adjustment in my whole lifestyle, especially since I live in a garden-style condo, no elevator, with a pooch needing care, etc. Enter orthopedic surgeon, who had to correct the podiatrist's correction by ever-so-slightly shortening the next two metatarsals, thus evening things up a bit, and not coincidentally making my whole left foot just a bit shorter than the right. That worked, at a cost of much more time, aggravation and life adjustment. I now have 5 screws in that foot.

Oh, he also corrected hammertoe in 4th toe, which now splays out when I walk, almost like something featured in a cat cartoon. If I walk barefoot for more than a short while, the third toe goes numb, no doubt from displacement due to 4th toe no longer doing its job.

Then a few years back I took a bad MS-related fall and broke all 3 bones in my right ankle, sort of mangled them. Surgery and a week in the hospital was followed by 5 months of PT, which didn't help all that much, and I now have 'post-traumatic arthritis' in that ankle (pain and swelling), along with 11 screws and a plate. Can't really blame anyone but myself for that, but I have learned to beware of doctors bearing scalpels.

The ortho who did that surgery would like nothing more than to get in there with a knife again and either fuse the ankle or replace the entire joint. Things will have to get a whole lot worse before that happens. Meanwhile another podiatrist who is making me orthotics at ruinous expense (luckily covered 90% by insurance) has been looking greedily at my Achilles tendons and their shortened state (may be an MS thing) and wants to do either surgery or a special series of laser treatments, not covered by insurance. Like that is ever going to happen. His beady little eyes got a frustrated look in them when I told him I had largely solved the pain problem in my left calf by the simple expedient of getting rid of a pair of ankle boots I'd been wearing most of this past winter of endless snow. If ever I do need surgery for the Achilles stuff, which would be a last resort after meds and PT, it ain't gonna be by a podiatrist.

Sorry that story veered off into me me me, but it does illustrate the fact that millimeters can well be what it's about. I wouldn't necessarily trust the opinion of the doctor who may have started the whole thing. Have you seen an orthopod?

Well, it's the middle of the night, and I just got up to get something to drink, so now I think I'll try lullaby land again.

Keep us posted on developments.

572651 tn?1531002957
Ess, you know I NEVER select a *best answer* until this morning - I so appreciate you taking the time to write out all of this.  It makes a lot of sense, and esepcially that i could really lose 50 pounds to begin with to really give my foot some relief.  

The good news is it only hurts when i walk on it, so sleeping and sitting are not a problem, for now.

I'm glad you made it about you, you, you - it helps me to see the bigger picture.  i hope you got back to sleep - it appears we are passing in the night.

hugs, Laura
Avatar universal
I do love a good mystery! :-)

Might not hurt to be checked for diabetes and I am guessing your blood pressure isn't high because that can sometimes cause weird swelling.

Also, I know my mother had foot and leg swelling and wears compression stockings due to severe arthritis in her back.

My father also used the stockings the last decade of his life due to a really aggressive case of lymphedema so I am praying there is nothing seriously wrong.

I hope you get an answer soon,
572651 tn?1531002957
Thanks, Corrie.  Yes, my sugar can be boderline but I have been pretty good lately but that thought came to mind.  

A local neuro at a talk last night asked if I had seen a rheumotologist, which fits your arthritis question.  I hate to add another 'ologist' to my stable of docs.

Some form of edema also crossed my mind, but I have to wonder about that because the pain/discomfort is ONLY when I am standing on it.  It does't hurt when i sit or sleep.

You have some good suggestions there.
hugs, Laura
1689801 tn?1333986916
I´m sorry your feet are hurting so much Laura. You have got a really good theories from both Ess and Corrie. I smiled when you said doctor House, because I gave my new neuro "my story" in writing (a little different version than you have seen in English) and I talked about needing some doctor House to help me figure this out :) there should be much more off "House´s" out there! We need them!

I hope will get your doctor House soon, so you will get better.
572651 tn?1531002957
Thanks, Dagun.  the good news is I had a massage today and had her work almost exclusively on my legs.  She did some lymphatic work and got the fluid moving some and I can now wiggle my toes, which I couldn't do before.

stay tuned for the next chapter
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