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Metatarsalagia

Posted by Mar on 5/31/02 at 10:28 (085895)

Has anyone had 'metatarsalagia'? I have been plagued by this for a year now following bunion surgery. I have custom orthotics and get ultrasound twice a week since November. Is it possible to get rid of this condition?? Mar

Re: Metatarsalagia

DR Zuckerman on 5/31/02 at 18:30 (085947)

Yes.

Sometimes the reason is from the position of the head of the first metatarsal . Did they can and move the head in a new different postion or direction?

Re: Metatarsalagia

Mar on 5/31/02 at 19:58 (085953)

Dr Z --

Well, I guess the first metatarsal was moved because they cut the bone and moved it over. That bone on the edge is very sensitive, the bipartite sesamoid is inflammed and sore, and the whole ball of the foot is painful -- this is a year of pain and 15 months since the surgery. Sometimes it is not as bad as other times. Of course I haven;t been doing much walking because of the PF. The little toe bunion was shaved and that is sore as hell too. I had ESWT a week ago for the bilateral PF (which I had since November) and am hoping that when the heels heal, the ball of the foot might too???? Thanks for any light you can shed on this. Mar

Re: Metatarsalagia

Ed Davis, DPM on 6/01/02 at 12:53 (086011)

The problematic biomechanics that lead to formation of a bunion may still exist after a bunionectomy. ESWT amy help but if the biomechanics are not addressed the problem may persist. Orthotics should lead to rapid resolution.
Ed

Re: Metatarsalagia

Mar on 6/02/02 at 07:19 (086060)

Docs --

I have been wearing custom orthotics almost exclusively since the end of December -- still have the metatarsalgia and sesamoiditis -- ice it regularly -- have ultrasound treatments twice a week. Had my first pair of custom orthotics last August but we could never get them adjusted right and they provided no relief for the ball of the foot. (They actually aggravated my good foot and started all kinds of problems there.) When I changed pods in Nov, he fitted me for the ones I currently use. Any other ideas??? I am beginning to think that this will never go away and I will never be able to walk much and be active again. Thanks -- Mar

Re: Metatarsalagia

DR Zuckerman on 6/02/02 at 09:00 (086066)

Do you have hammer toes or do your toes bend when walking?

Re: Metatarsalagia

Mar on 6/02/02 at 12:23 (086081)

Dr. Z --

No hammer toes. They bend normally when I walk. The little toe doesn;t bend back since the surgery and the big toe only a little. I just can;t put full weight on the ball of the foot -- the 1st, 4th and 5th metatarsals are very painful as is the whole ball of the foot. I had this condition for about 2 months - the painful ball of foot (NOv/Dec 2000) after I had broken the little toe in Oct. 2000 but it went away. I foolishly went for bunion surgery afraid that the condition would come back without it. The joke's on me -- it came back because of the surgery and now it won;t go away! Okay, I am rambling on -- sorry -- any suggestions?? Mar

Re: Metatarsalagia

DR Zuckerman on 6/02/02 at 13:15 (086087)

You need the motion in the big toe joint or else all your weight is being placed where it is now. May need either a fusion or a big to implant. Sorry that what it looks like now

Re: Metatarsalagia

Mar on 6/02/02 at 17:54 (086103)

Maybe I said it wrong -- I can bend all the toes, including big toe, forward -- like to walk -- but I just can;t bend them back like towards the sole of the foot. If I bend the big toe too far forward, like if I were to wear very high heel shoes (haha), then it pulls on the fascia and sesamoid. Mar

Re: Metatarsalagia

DR Zuckerman on 6/02/02 at 18:08 (086104)

So you can bend the big toe joint back toward your nose ? The sesamoid bones must be able to move and the first metatarsal head must be able to touch the floor when you stand. Does the big toe touch the floor when you stand. go to a mirrow or have someone look . When you are standing does the big toe touch the ground. I am willing to bet that you have is called hallux elevatus. The first ray which includes the big toe joint isn't accepting it share of weight during the gait cycle. The doctors made you orthosis to try and compensate for this problem but it just isn't working for you.

If you can live with it that fine but if you can't you need to get a second opinion and see if a surgical repair is needed and if it can be corrected

Re: Metatarsalagia

Mar on 6/02/02 at 18:13 (086105)

Yes, my big toe touches the ground when I stand. Mar

Re: Metatarsalagia

Ed Davis on 6/03/02 at 14:56 (086158)

Unfortunately, the term 'metatarsalgia' is not really a diagnosis. It just means 'pain in the ball of the foot.'

Has your doc provided you with a specific diagnosis? If not, please ask him or her to do so. The are that is causing a problem is still not clear despite reading further posts and responses.

The construction of your orthotics may need to be looked at. I have found that most types of metatarsal pain can be helped with the right orthotic.

Where do you live?
Ed

Re: Metatarsalagia

Mar on 6/03/02 at 16:09 (086172)

Ed --

I live in Teaneck, NJ. Diagnosis - well ??? Inflammed bipartite sesamoid, fibrosis, mild inflammation, and confusion???? Here is the story: I had bunion surgery on the right foot (big and little toe) 15 months ago. The little toe stitches did not dissolve and area was severely inflammed. Had surgery in May 2001 to remove the inflammed tissue and stitches. The pain in the ball of the foot started exactly a year ago, in June 2001, after the second set of stitches was removed. The pod I was going to then, who did the surgery, dismissed it as healing and humidity and told me to be patient, which I was all last summer. Finally in August he made orthotics which did not help at all and only aggravated the left foot too. In the fall I insisted on xrays from which he diagnosed a stress fracture in the sesamoid (which turned out to be wrong). I started walking on my heels to protect the sesmoid and developed horrendous heel pain in November 2001. Switched pods -- sent me for CT and discovered inflammed bipartite sesamoid, not stress fracture. New orthotics with accomodation for sesamoid, ultrasound twice a week, icing, rest, stretching, antiinflammatories (which I couldn;t take -- IBS), cortisone shots, medrol, acupuncture, taping, chiropractor, nerve tests (normal) - diagnosis PF, B6, painkillers (can't take IBS), Pain Management Center -bone scan - no huge results, etc. By November, however, the heelpain was far worse than the ball of the foot and we treated both with emphasis on the PF. Went for ESWT 2 weeks ago to another pod and will see him again next week. Still go to my regular pod for ultrasound twice a week. No one really can figure out why the ball of the foot doesn;t respond and the pain go away. In the humidity it swells like crazy, Every morning it is a little swollen too. I use heat on the heels after the ESWT and ice on the ball of the foot. The only thing that doesn;t cause pain is not walking or standing at all! All 3 pods say the xrays show a good bunion surgery. Soooooo -- any suggestions??? Thanks for reading all this (and it is a short synopsis!!) Mar

Re: Metatarsalagia

Ed Davis on 6/03/02 at 19:09 (086188)

Quite a history!!
How is your heel pain doing? Reason--- the plantar fascia is most commonly inflamed at its attachment to the heel bone but, OCCASIONALLY, distal plantar fasciitis occurs. Distal plantar fasciitis involves inflammation of the plantar fascia near its attachment just behind the big toe joint.

There are a number of structures attaching in and around the big toe joint, including the distal end of the plantar fascia. If that is the case, ESWT may be an option. How close are you to Dr. Z's office?
Ed

Re: Metatarsalagia

Mar on 6/03/02 at 19:26 (086191)

I had ESWT on the heels with Dr. Wishnie 12 days ago. Dr. Z recommended him as he is closer to me than Dr. Z. So now I am waiting with hope to see the heel pain disappear. Dr. W said that when the fascia heals, it may also help the sesamoiditis as the fascia will not be as tight and not pull as much on the sesamoid area??? I think this is what he said! I sure hope so. Should the ESWT be aimed at the distal plantar fascia??? I'll ask Dr. W. when I see him next week for my 3 week follow-up. Mar

Re: Metatarsalagia

Ed Davis, DPM on 6/04/02 at 19:18 (086300)

Please keep me posted! Ask him to take a look at the plantar fascial attachment behind the big toe joint.
Ed

Re: Metatarsalagia

Mar on 6/04/02 at 21:44 (086318)

Ok -- I will ask him next Tuesday. Thanks for your concern and interest. it means a lot. Mar

Re: Metatarsalagia

DR Zuckerman on 5/31/02 at 18:30 (085947)

Yes.

Sometimes the reason is from the position of the head of the first metatarsal . Did they can and move the head in a new different postion or direction?

Re: Metatarsalagia

Mar on 5/31/02 at 19:58 (085953)

Dr Z --

Well, I guess the first metatarsal was moved because they cut the bone and moved it over. That bone on the edge is very sensitive, the bipartite sesamoid is inflammed and sore, and the whole ball of the foot is painful -- this is a year of pain and 15 months since the surgery. Sometimes it is not as bad as other times. Of course I haven;t been doing much walking because of the PF. The little toe bunion was shaved and that is sore as hell too. I had ESWT a week ago for the bilateral PF (which I had since November) and am hoping that when the heels heal, the ball of the foot might too???? Thanks for any light you can shed on this. Mar

Re: Metatarsalagia

Ed Davis, DPM on 6/01/02 at 12:53 (086011)

The problematic biomechanics that lead to formation of a bunion may still exist after a bunionectomy. ESWT amy help but if the biomechanics are not addressed the problem may persist. Orthotics should lead to rapid resolution.
Ed

Re: Metatarsalagia

Mar on 6/02/02 at 07:19 (086060)

Docs --

I have been wearing custom orthotics almost exclusively since the end of December -- still have the metatarsalgia and sesamoiditis -- ice it regularly -- have ultrasound treatments twice a week. Had my first pair of custom orthotics last August but we could never get them adjusted right and they provided no relief for the ball of the foot. (They actually aggravated my good foot and started all kinds of problems there.) When I changed pods in Nov, he fitted me for the ones I currently use. Any other ideas??? I am beginning to think that this will never go away and I will never be able to walk much and be active again. Thanks -- Mar

Re: Metatarsalagia

DR Zuckerman on 6/02/02 at 09:00 (086066)

Do you have hammer toes or do your toes bend when walking?

Re: Metatarsalagia

Mar on 6/02/02 at 12:23 (086081)

Dr. Z --

No hammer toes. They bend normally when I walk. The little toe doesn;t bend back since the surgery and the big toe only a little. I just can;t put full weight on the ball of the foot -- the 1st, 4th and 5th metatarsals are very painful as is the whole ball of the foot. I had this condition for about 2 months - the painful ball of foot (NOv/Dec 2000) after I had broken the little toe in Oct. 2000 but it went away. I foolishly went for bunion surgery afraid that the condition would come back without it. The joke's on me -- it came back because of the surgery and now it won;t go away! Okay, I am rambling on -- sorry -- any suggestions?? Mar

Re: Metatarsalagia

DR Zuckerman on 6/02/02 at 13:15 (086087)

You need the motion in the big toe joint or else all your weight is being placed where it is now. May need either a fusion or a big to implant. Sorry that what it looks like now

Re: Metatarsalagia

Mar on 6/02/02 at 17:54 (086103)

Maybe I said it wrong -- I can bend all the toes, including big toe, forward -- like to walk -- but I just can;t bend them back like towards the sole of the foot. If I bend the big toe too far forward, like if I were to wear very high heel shoes (haha), then it pulls on the fascia and sesamoid. Mar

Re: Metatarsalagia

DR Zuckerman on 6/02/02 at 18:08 (086104)

So you can bend the big toe joint back toward your nose ? The sesamoid bones must be able to move and the first metatarsal head must be able to touch the floor when you stand. Does the big toe touch the floor when you stand. go to a mirrow or have someone look . When you are standing does the big toe touch the ground. I am willing to bet that you have is called hallux elevatus. The first ray which includes the big toe joint isn't accepting it share of weight during the gait cycle. The doctors made you orthosis to try and compensate for this problem but it just isn't working for you.

If you can live with it that fine but if you can't you need to get a second opinion and see if a surgical repair is needed and if it can be corrected

Re: Metatarsalagia

Mar on 6/02/02 at 18:13 (086105)

Yes, my big toe touches the ground when I stand. Mar

Re: Metatarsalagia

Ed Davis on 6/03/02 at 14:56 (086158)

Unfortunately, the term 'metatarsalgia' is not really a diagnosis. It just means 'pain in the ball of the foot.'

Has your doc provided you with a specific diagnosis? If not, please ask him or her to do so. The are that is causing a problem is still not clear despite reading further posts and responses.

The construction of your orthotics may need to be looked at. I have found that most types of metatarsal pain can be helped with the right orthotic.

Where do you live?
Ed

Re: Metatarsalagia

Mar on 6/03/02 at 16:09 (086172)

Ed --

I live in Teaneck, NJ. Diagnosis - well ??? Inflammed bipartite sesamoid, fibrosis, mild inflammation, and confusion???? Here is the story: I had bunion surgery on the right foot (big and little toe) 15 months ago. The little toe stitches did not dissolve and area was severely inflammed. Had surgery in May 2001 to remove the inflammed tissue and stitches. The pain in the ball of the foot started exactly a year ago, in June 2001, after the second set of stitches was removed. The pod I was going to then, who did the surgery, dismissed it as healing and humidity and told me to be patient, which I was all last summer. Finally in August he made orthotics which did not help at all and only aggravated the left foot too. In the fall I insisted on xrays from which he diagnosed a stress fracture in the sesamoid (which turned out to be wrong). I started walking on my heels to protect the sesmoid and developed horrendous heel pain in November 2001. Switched pods -- sent me for CT and discovered inflammed bipartite sesamoid, not stress fracture. New orthotics with accomodation for sesamoid, ultrasound twice a week, icing, rest, stretching, antiinflammatories (which I couldn;t take -- IBS), cortisone shots, medrol, acupuncture, taping, chiropractor, nerve tests (normal) - diagnosis PF, B6, painkillers (can't take IBS), Pain Management Center -bone scan - no huge results, etc. By November, however, the heelpain was far worse than the ball of the foot and we treated both with emphasis on the PF. Went for ESWT 2 weeks ago to another pod and will see him again next week. Still go to my regular pod for ultrasound twice a week. No one really can figure out why the ball of the foot doesn;t respond and the pain go away. In the humidity it swells like crazy, Every morning it is a little swollen too. I use heat on the heels after the ESWT and ice on the ball of the foot. The only thing that doesn;t cause pain is not walking or standing at all! All 3 pods say the xrays show a good bunion surgery. Soooooo -- any suggestions??? Thanks for reading all this (and it is a short synopsis!!) Mar

Re: Metatarsalagia

Ed Davis on 6/03/02 at 19:09 (086188)

Quite a history!!
How is your heel pain doing? Reason--- the plantar fascia is most commonly inflamed at its attachment to the heel bone but, OCCASIONALLY, distal plantar fasciitis occurs. Distal plantar fasciitis involves inflammation of the plantar fascia near its attachment just behind the big toe joint.

There are a number of structures attaching in and around the big toe joint, including the distal end of the plantar fascia. If that is the case, ESWT may be an option. How close are you to Dr. Z's office?
Ed

Re: Metatarsalagia

Mar on 6/03/02 at 19:26 (086191)

I had ESWT on the heels with Dr. Wishnie 12 days ago. Dr. Z recommended him as he is closer to me than Dr. Z. So now I am waiting with hope to see the heel pain disappear. Dr. W said that when the fascia heals, it may also help the sesamoiditis as the fascia will not be as tight and not pull as much on the sesamoid area??? I think this is what he said! I sure hope so. Should the ESWT be aimed at the distal plantar fascia??? I'll ask Dr. W. when I see him next week for my 3 week follow-up. Mar

Re: Metatarsalagia

Ed Davis, DPM on 6/04/02 at 19:18 (086300)

Please keep me posted! Ask him to take a look at the plantar fascial attachment behind the big toe joint.
Ed

Re: Metatarsalagia

Mar on 6/04/02 at 21:44 (086318)

Ok -- I will ask him next Tuesday. Thanks for your concern and interest. it means a lot. Mar