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PF / Neuroma / Entrapment / Ligament

Posted by Bill Wood on 7/10/03 at 15:46 (123957)

PF: Jan '02, orthotripsy left foot. Prescribed orthotics post-ortho. Got nearly immediate relief from the orthotripsy but it only lasted about 10 - 12 months. Almost from day one with orthotics I felt like I was walking on the side of my foot. Went back for adjustment twice. Like a dummy; still wearing them until recently.

Neuroma: May '03, pain in left foot unbearable. Did not go back to the orthopedic surgeon. Went to my podiatrist. He said I have neuroma in left foot (outside 2 toes). Four consecutive weeks of injections and put in 'ski boot'. X-rays show slight return of PF; nothing else.

Entrapped Nerve: After two weeks of physical therapy and the aforementioned injections, podiatrist suspects entrapped nerve. Neuroma progressed down entire left (outside) of foot to behind the heel. PT had marginal effect. Therapist and podiatrist now think possible ligament damage or tear. Podiatrist instructed me to get rid of the orthotics (better late than never, I suppose). He believes, and I agree, that the realy problem started when I began using them.

Going for MRI tomorrow. Back to podiatrist next week. Conservative options: walking cast, hard cast, crutches, etc. Will also likely undergo orthotripsy for the PF again soon.

Please give me your opinion from what you can discern from my outline above.

Re: PF / Neuroma / Entrapment / Ligament

Dr. Z on 7/10/03 at 17:22 (123980)

Hi

The mri will help to determine if there is any ligament/tendon tear.
Many times compensation from plantar fascia pain can cause neuroma formation in between the toes. Orthosis can also create problems if the prescription is incorrect.
Let us know the results of the mri testing

Re: PF / Neuroma / Entrapment / Ligament

Ed Davis, DPM on 7/10/03 at 20:08 (124012)

Bill:

Did you mention problem with orthotics to your doc? If they are faulty, they may not work and can, at times, create other problems,
Ed

Re: PF / Neuroma / Entrapment / Ligament

Bill Wood on 7/18/03 at 15:53 (124747)

I don't know if you received my reply this morning or not, so I am resending it.

Here is the impression from the MRI:

Mild tenosynovitis of the left peroneus longus tendon at a level just distal to the lateral malleolus. In addition, there is very subtle linear abnormal signal located within the tendon extending from the distal tip of the lateral malleolus to a level roughly 1 cm distal to the lateral malleolus. This may represent granulation tissue at a site of previous tear. Moderate amount of edema seen within Kager's fat pad. Moderate amount of nonspecific edema seen to the subcutaneous fat of the posterior half of the left ankle and superficial to the left lateral malleolus.

What do you think, Doctor?