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Forefoot Pain and 1st MTP joint.

Posted by Katharine on 4/06/02 at 15:15 (078690)

My foot pain started about 10 years ago an occurred in spring and fall in my right big toe. As it would disappear after rest, and about a week, I never investigated. I've always noticed that if on my feet too long, they burn under the forefoot.

1.5 years ago, I went on a fitness craze, and began walking and cycling about 45 minutes daily. My big toe on my right foot began to hurt. I thought I could walk through it, bought new shoes, but eventually quit walking and cycling due to pain. The pain eased enough for awhile, but in six months I was in agony with burning throughout my forefoot. I this time I did not notice localized pain in the big toe. This was in May.

Then, in August (4 months later), the general pain in my feet eased, but I was left with pain in my big toe joint. It hurt to but any weight on my forefoot big toe joint. I had gone to my doctor several times at this point, but he said nothing was wrong.

Finally, in Novemver, (4 months later), I went to my physician and insisted on X-rays. I was told I had osteoarthritis of the first MTP joint. I then went to a rhuematologist who looked at x-rays and said that my 1st MTP joint had no bony spurs and was rounded. I did have a small bump on the top of the joint, but this could be genetic he said. So, no reason why my toe shoud hurt apparently.

I went for another opinion to a podiatrist. He suggested possible sesamoiditis. I am on anti-inflammatories (Celebrex) and have been on them 1 month. They are helping mildly, but I cannot really walk properly. I've had orthotics made to distribute weight under metatarsal heads, but this helps only a little as well. I want to be fixed! I want to be able to bend. Right now I cannot go down steps, as it is painful. I cannot bend to get into bottom kitchen cupboard. My toe sometimes feels stiff, and an other times it feels like it is too limber and bends too far when I toe off. I would really like to confirm diagnosis. Do you have any ideas. Not being able to toe off is a really difficult problem.

Re: Forefoot Pain and 1st MTP joint.

Dr. Zuckerman on 4/06/02 at 16:03 (078698)

You could have a flexor tear or a stress fracture in the sesmoid. It is time for an mri. The surface of the joint could be injured

Re: Forefoot Pain and 1st MTP joint.

Ed Davis, DPM on 4/06/02 at 16:04 (078700)

Katharine:

We really need an accurate diagnosis before being able to look at treatments. Sesamoiditis (an inflammation of the small floating bones beneath the big toe joint) is treated one way and hallux rigidus/limitus (painful limited range of motion of the big toe joint) is treated another way. Your rheumatologist's interpretation clues me that there may be a functional 'jamming' of the big toe joint. That can be treated via physical therapy and orthotics. The goal of the orthotic is to facilitate big toe joint motion and relieve jamming-- something your current orthotic may not be doing.

You may benefit from evaluation by a podiatrist with a strong biomechanical background. Where do you live?
Ed

Re: Forefoot Pain and 1st MTP joint.

Ed Davis, DPM on 4/06/02 at 16:05 (078701)

Wow Dr. Z, did you look at the time of our posts? We both answered at the same time. Great minds think alike.
Ed

Re: Forefoot Pain and 1st MTP joint. ultrasound

Ed Davis, DPM on 4/06/02 at 16:10 (078702)

PS Dr. Z
This is a case where I love my diagnostic ultrasound machine. It can demonstrate tears like potential one you mentioned without MRI-- you can pick them up in the office in minutes. I bought my machine about a year after a big price break. There are some even better and less expensive ones designed for extremities out this year. Let me know if you are interested and I can refer you to some sources.
Ed

Re: Forefoot Pain and 1st MTP joint. ultrasound

Dr. Zuckerman on 4/06/02 at 16:36 (078712)

Great minds think alike. I like that. I now have an ultrasound machine. It came with my Dornier EPOS. The quality of resolution is amazing and so was the attached price tag of $36,000. I couldn't take the ultrsound machine off the price it cas ESWT plus ultrsound machine go together. On another note the electromagnetic method of Sound wave production is so smooth and quiet and quick. Nothing like that dam loud sparkgap. Let hope the repairs are less.

Re: ultrasound

Ed Davis, DPM on 4/08/02 at 20:20 (078866)

Dr. Z:

Jeffrey Stone, DPM of Fresno, CA is sort of the guru of podiatric ultrasound. He sets up training courses. Now that you have the diagnostic ultrasound it would be great to learn all the things that can be imaged with the unit. Many individuals who take a superficial glance at the technology feel that the image quality reveals less than MRI. That may be true at times but the key to ultrasound is the ability to place structures in motion while observing them. Jeff's number is 209-436-1213.
Ed

Re: ultrasound

Dr. Zuckerman on 4/08/02 at 21:37 (078875)

I know Jeff very well. He is going to be in Atlantic City next month and I have signed up for his course

Re: Forefoot Pain and 1st MTP joint.

Dr. Zuckerman on 4/06/02 at 16:03 (078698)

You could have a flexor tear or a stress fracture in the sesmoid. It is time for an mri. The surface of the joint could be injured

Re: Forefoot Pain and 1st MTP joint.

Ed Davis, DPM on 4/06/02 at 16:04 (078700)

Katharine:

We really need an accurate diagnosis before being able to look at treatments. Sesamoiditis (an inflammation of the small floating bones beneath the big toe joint) is treated one way and hallux rigidus/limitus (painful limited range of motion of the big toe joint) is treated another way. Your rheumatologist's interpretation clues me that there may be a functional 'jamming' of the big toe joint. That can be treated via physical therapy and orthotics. The goal of the orthotic is to facilitate big toe joint motion and relieve jamming-- something your current orthotic may not be doing.

You may benefit from evaluation by a podiatrist with a strong biomechanical background. Where do you live?
Ed

Re: Forefoot Pain and 1st MTP joint.

Ed Davis, DPM on 4/06/02 at 16:05 (078701)

Wow Dr. Z, did you look at the time of our posts? We both answered at the same time. Great minds think alike.
Ed

Re: Forefoot Pain and 1st MTP joint. ultrasound

Ed Davis, DPM on 4/06/02 at 16:10 (078702)

PS Dr. Z
This is a case where I love my diagnostic ultrasound machine. It can demonstrate tears like potential one you mentioned without MRI-- you can pick them up in the office in minutes. I bought my machine about a year after a big price break. There are some even better and less expensive ones designed for extremities out this year. Let me know if you are interested and I can refer you to some sources.
Ed

Re: Forefoot Pain and 1st MTP joint. ultrasound

Dr. Zuckerman on 4/06/02 at 16:36 (078712)

Great minds think alike. I like that. I now have an ultrasound machine. It came with my Dornier EPOS. The quality of resolution is amazing and so was the attached price tag of $36,000. I couldn't take the ultrsound machine off the price it cas ESWT plus ultrsound machine go together. On another note the electromagnetic method of Sound wave production is so smooth and quiet and quick. Nothing like that dam loud sparkgap. Let hope the repairs are less.

Re: ultrasound

Ed Davis, DPM on 4/08/02 at 20:20 (078866)

Dr. Z:

Jeffrey Stone, DPM of Fresno, CA is sort of the guru of podiatric ultrasound. He sets up training courses. Now that you have the diagnostic ultrasound it would be great to learn all the things that can be imaged with the unit. Many individuals who take a superficial glance at the technology feel that the image quality reveals less than MRI. That may be true at times but the key to ultrasound is the ability to place structures in motion while observing them. Jeff's number is 209-436-1213.
Ed

Re: ultrasound

Dr. Zuckerman on 4/08/02 at 21:37 (078875)

I know Jeff very well. He is going to be in Atlantic City next month and I have signed up for his course