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A different area for pain

Posted by D.J. on 1/09/02 at 16:10 (069378)

I have an injury that has puzzled many doctors and would love to hear other opinions. I originally injured my foot during a run a couple years ago. The pain was originally right in the center of my arch. Now, the most painful area is between the arch and the sole near the MTP joint of the big toe. Two MRIs, Xray, and bonescan have showed nothing. I have baffled 5 doctors and a MPT. I have been in the Aircast twice and only seemed to get worse after two months in the cast. I've also tried crutches, three pairs of orthotics and several different prolotherapy methods but my condition only seems to get worse. Although I've been diagnosed with Plantar Fasciitis and a torn Plantar Fascia, my current dr. and physical therapist seem to thing that I have a ligament that is ruptured at the MTP joint causing the arch to fall and the plantar fascia to overcompensate. Has anyone dealt with a condition similar to this?

Re: A different area for pain

Ed Davis, DPM on 1/09/02 at 21:39 (069424)

There are several things to look at at the base of the big toe. Two small sesamoid bones (like little kneecaps) are enveloped by tendons and glide below and just behind the joint. A portion of the plantar fascia also attaches to the proximal aspect of the joint more superficially.

Any mention of the sesamoid apparatus by your doctors?
Ed

Re: A different area for pain

D.J on 1/09/02 at 22:57 (069436)

Thanks for your response Dr. Davis. I've had a couple dr's mention the Sesamoid bones but have ruled out any problems after the bonescan showed nothing abnormal. I also was given a subscription for a nasal spray that I believe was called Miacalcin. THis medicine was supposed to help any bone problems. I may have given the wrong name for the joint where my pain is in an attempt to be as accurate as possible. My main trigger point is toward the front of the arch about an inch before the base of the big toe (or in my nonmedical terms the callusy part of big toe base). I've also had a physical therapist notice that my cuboid was subluxed. After manipulating the cuboid back into place the pain did not go away as aspected leading her to believe something else was the problem. What is the name of the joint in this area? Have you had any patients with pain in this particular area? Thanks again

Re: A different area for pain

Ed Davis, DPM on 1/11/02 at 19:32 (069688)

It is hard to say. One inch before the base of the big toe would place the area at the first metatarsal shaft, not a joint. The plantar fascia can cause problems in that area as can the flexor tendons to the big toe.
Ed

Re: A different area for pain

Ed Davis, DPM on 1/09/02 at 21:39 (069424)

There are several things to look at at the base of the big toe. Two small sesamoid bones (like little kneecaps) are enveloped by tendons and glide below and just behind the joint. A portion of the plantar fascia also attaches to the proximal aspect of the joint more superficially.

Any mention of the sesamoid apparatus by your doctors?
Ed

Re: A different area for pain

D.J on 1/09/02 at 22:57 (069436)

Thanks for your response Dr. Davis. I've had a couple dr's mention the Sesamoid bones but have ruled out any problems after the bonescan showed nothing abnormal. I also was given a subscription for a nasal spray that I believe was called Miacalcin. THis medicine was supposed to help any bone problems. I may have given the wrong name for the joint where my pain is in an attempt to be as accurate as possible. My main trigger point is toward the front of the arch about an inch before the base of the big toe (or in my nonmedical terms the callusy part of big toe base). I've also had a physical therapist notice that my cuboid was subluxed. After manipulating the cuboid back into place the pain did not go away as aspected leading her to believe something else was the problem. What is the name of the joint in this area? Have you had any patients with pain in this particular area? Thanks again

Re: A different area for pain

Ed Davis, DPM on 1/11/02 at 19:32 (069688)

It is hard to say. One inch before the base of the big toe would place the area at the first metatarsal shaft, not a joint. The plantar fascia can cause problems in that area as can the flexor tendons to the big toe.
Ed