Plantar forefoot pain

[RDL]

I'm a 55 y.o. male in good health and last complete physical 11 months ago revealed no problems.  2 years ago I had peroneal tendon surgery.  The brevis was debrided near insertion at 5th met base and the longus was so deteriorated it was execised and attached to the brevis several inches above the lateral ankle.  I progressed slowly but steadily and 18 months after surgery had worked up to 5 miles on the elliptical and 20 miles on the stationary bike.  One morning I awoke and upon standing felt a moderately sharp pain under my 5th met head.  It also felt like there was something bumpy under the foot.  Pain continued to worsen until I could only walk a short distance.  MRI showed nothing and the pod put me in a non-weightbearing splint for 4 weeks.  The pain was gone and I slowly progressed to walking 1200 steps, riding the bike, and short periods on the eliptical.  Then the pain came back and got progressively worse over a 30 day period.  Pain feels like a hornet sting under the 5th met head and compression with the fingers on the bottom of the foot near the 5th met base produces a sharp pain between the 4th & 5th toes.  Toes 3-5 (little toe is 5) feel slightly numb/swollen/ funny.  I seem to have all toe sensation to touch, pinching, cold, heat, etc.  When in shoes I can feel some swelling along the outside foot bottom from the 5th met head to the 5th met base.  Pain dissipates with rest and swelling diminishes with ice and elevation.

Dr. feels that losing my longus is causing the foot to strike incorrectly, putting undue pressure on the lateral plantar foot.  He also said he had never seen a neuroma in the 4th interspace.  I'm wondering if a nerve is pinched somewhere?

Any thoughts would be much appreciated.

[crwstar]

Isn't that the truth!! It is hard to know what to do when you don't know what's wrong! I think many of us can write books about that topic alone ;-)
I did read that whether its capsulitis or even a neuroma issue that you want to make sure you have good support at your forefoot. And it can be challenging knowing which one it is. Don't hesitate to msg me if you have any questions down the road, especially if you need a metatarsal pad. You take care of yourself and let us/me know how you are getting along.

[RDL]

Thanks so much for the good advice and support Crwstar.  It's difficult to know what to do when you don't know what's wrong.  Dr. thinks I have capsulitis but the slight toe numbness and the ability to produce pain by pressing several inches below the painful area makes me wonder.

[crwstar]

I do hear your delima and wish it could be easier. I've seen many many people get better over time with foot issues. Not gauranteed but I have definitly seen it happen. Keep this in mind - your orthotics may or may not change the way you wear your current shoes. Nothing to worry about now but good information to have if it does happen.

With the foot problem I had, I was out walking my dog one day and was a few blocks from home. I absolutely thought I would not make it home my feet were hurting so bad. It took some time but when I got my orthotics and the right shoes to help with "shoe strike" I eventually returned to good foot health. When you get your orthotics it is possible you are going to be breaking them in over a week and for you you might do it over a longer period of time since you aren't weight bearing. You know, start out wearing them 1 hour for the first day and 2 hours the next day and so on. This way your foot adjusts to the new pressure over a period of time. I wish you a speedy recovery and remember don't over do it.

I made the mistake of wearing my orthotics 8 hours on the first day because they felt great and ended up increasing my foot problem ;-)

[RDL]

Thanks for the reply Crwstar.  My Dr. has ordered some custom orthotics which should soon be in.  My problem is I don't know how I'm going to get well enough to walk in them.  Right now I'm non-weightbearing with crutches.  I was hoping to get well while on crutches and "start over" again with better footgear.

[crwstar]

Hi,

I can't get into the medical side of what's going on with you but you might consider finding a shoe retailer that specializes in selling shoes that are recommended by foot doctors. Seems like you may need to be in a shoe that is wider at the forefoot and takes pressure off that area. Yes, you can get really good shoes that are good looking without buying orthopedic looking shoes ;-) often times after surgery we can't wear the same shoes.....look into what's called the New balance 926. Doesn't look pretty but does the job.

Crwstar