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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:
MS
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
Pt history:
MS
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
Oh, Laura. I do hope that the healing of the fracture will at least take some of your pain away, likewise the injection. I'm sorry to hear it's down to multiple issues and that a surgery with such a challenging recovery period is in your future.
Thank you for updating us. Please keep us in the loop about your follow-up appointment this week. I'm thinking of you.
Thank you for updating us. Please keep us in the loop about your follow-up appointment this week. I'm thinking of you.
I was thinking might mouse, too, PD.
My update -
It is no surprise - I definitely have a stress fracture in my left foot - 3rd metatarsal if that means anything to you. I also have a rupture of the synovium on the 2nd metatarsal bone. That is the pocket of fluid that cushions the joint when we walk.
For now my plan is to see if we can do a temporary patch job but the reality is eventually it will have to be surgically repaired . I am now in a full boot up to my knee to stabilize the foot and allow the stress fracture to heal - that will be rechecked in 4 weeks. They will get me in yet this week to do an injection in my toe - much like the stuff they put into knees when the cushion is worn down. I'm hoping I can do one or two of these and get to fall or early winter and then do the surgery, if not later. That one involves absolutely no weight bearing for 6 weeks or so and I'm not so sure about rolling around on one of those knee scooters with my balance.
The podiatrist said the rupture comes from the hammertoe and the stress fracture comes from the 2nd metatarsal pushing into the 3rd and causing that much pressure.
so that's the news for now, unfortunately.
Laura
My update -
It is no surprise - I definitely have a stress fracture in my left foot - 3rd metatarsal if that means anything to you. I also have a rupture of the synovium on the 2nd metatarsal bone. That is the pocket of fluid that cushions the joint when we walk.
For now my plan is to see if we can do a temporary patch job but the reality is eventually it will have to be surgically repaired . I am now in a full boot up to my knee to stabilize the foot and allow the stress fracture to heal - that will be rechecked in 4 weeks. They will get me in yet this week to do an injection in my toe - much like the stuff they put into knees when the cushion is worn down. I'm hoping I can do one or two of these and get to fall or early winter and then do the surgery, if not later. That one involves absolutely no weight bearing for 6 weeks or so and I'm not so sure about rolling around on one of those knee scooters with my balance.
The podiatrist said the rupture comes from the hammertoe and the stress fracture comes from the 2nd metatarsal pushing into the 3rd and causing that much pressure.
so that's the news for now, unfortunately.
Laura
My "then" belongs in the next sentence following the one in which it appeared. Smart phone, my foot.
I am very, very careful in buying shoes. Several months as a retail greeter were disastrous for my feet, and ever since, I've been among the world's slowest shoe shoppers.
For one thing, the old dogs have very high arches, so much so that I must buy EEEE width, in order to get enough leather to lace together up on top of the foot. When I shop for shoes, I will then try 1st to determine what the store has in my size. If anything, I try to start at the bottom of the price range, working my way up until something aesthetically acceptable feels unlikely to torture me in the first week.
LauraLu, we will continue to pray that you find relief.
For one thing, the old dogs have very high arches, so much so that I must buy EEEE width, in order to get enough leather to lace together up on top of the foot. When I shop for shoes, I will then try 1st to determine what the store has in my size. If anything, I try to start at the bottom of the price range, working my way up until something aesthetically acceptable feels unlikely to torture me in the first week.
LauraLu, we will continue to pray that you find relief.
I've had bunion surgery on both feet. On my left the bunion is coming back and though it is still "smallish" compared to before surgery it is much more painful along the scar. So scar tissue/ a touch of arthritis from the previous surgery and the bunion coming back causes pain! sleeping on my side with my foot on its side is painful again... argh hate having bad feet. I just dropped 150 dollars on new running shoes and foot still hurts! Bought anothe pair of new running shoes a few months ago and can't wear them as they rub the scar and are to painful
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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.
ess