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Diagnostics to discern reason for forefoot pain

Posted by Gregg W on 2/03/04 at 22:24 (143591)

I've had bilateral foot problems for 6 long years. For 3 years I had classic PF, underwent ESWT on left heel, no effect. 3 years ago my forefeet became more painful.

I now have middle of the forefoot pain upon walking or standing. Balls of my feet feel full and tight. When my feet flare up they get hot and reddened with some swelling mostly in forefoot, toes. Podiatrist's have worked the Morton's neuroma region, but I do not feel any sharp pain when that is done. No clicking either.

I've had no cortisone shots yet, no surgery. Tried everything else. It's slowly getting worse. Is there any way to determine what's going on before I risk shots, surgery, etc? I had an MRI of heel with some cuts of the forefoot, it showed nothing out of normal. Thanks for any help.

Re: Diagnostics to discern reason for forefoot pain

Pauline on 2/03/04 at 22:47 (143594)

Thank you for posting also. How long ago did you have your ESWT treatment? The reason for my asking is because I'm wondering if your foot is now exhibiting symptoms relating to your treatment. I'm not a doctor just another poster like you trying to connect the dots about this condition that causes sooo many people to suffer.

Re: Diagnostics to discern reason for forefoot pain

Gregg W on 2/04/04 at 08:46 (143603)

I had ESWT about 3 years ago. Six months prior to the pain moving to my forefoot. However, I only had ESWT on my left foot, and the pain moved in both my left, then also my right foot.

The only other thing I have not tried is casting.

Re: Diagnostics to discern reason for forefoot pain

Dr. David S. Wander on 2/04/04 at 19:10 (143640)

Have you had any blood tests to determine if you may have an arthritic condition??? When patients do not respond to conservative care, and have migratory discomfort (pain that has moved) and the pain is bilateral, I will often perform blood work or refer the patient to a rheumatologist as a second opinion. This is an issue you may want to discuss with your podiatrist.

Re: Diagnostics to discern reason for forefoot pain

Dr. Z on 2/04/04 at 20:42 (143645)

How is the rest of your lower extremity. It sure sounds like a progession of your heel pain. I am sure you are walking differently due to the continueal heel pain . Many patients will develop neuromas, bursitis, distal plantar fasciitis. Any one think about RSD?

Re: Diagnostics to discern reason for forefoot pain

Gregg W on 2/05/04 at 08:26 (143663)

An excellent recommendation. I have had numerous blood tests done. My white count and platelets are borderline low. I've had ANA, Lyme disease, and a host of arthritic tests. They were all negative, except I was positive for HLA-B27. I've been taking Sulfasalizine for 5 weeks, no difference so far, but I hear that it takes a while. Still slowly increasing the dosage at this point.

Re: Diagnostics to discern reason for forefoot pain

Gregg W on 2/05/04 at 08:31 (143665)

My calves feel tight. I work as a software engineer and as the day of sitting (and stress) goes on my muscles get tight. Yes I am walking differently. Nobody has ever mentioned RSD before, but after looking it up, it's certainly a possibility. The skin of my feet seems hypersensitive. My littlest toes are red and sore from rubbing against my shoes. I have cut a top hole out of a pair of clogs so that my littlest toes do not rub. I also wear the finest weave socks I can find. Very interesting idea Dr. Z., thanks.

Re: Diagnostics to discern reason for forefoot pain

Gregg W on 2/05/04 at 10:30 (143678)

After looking into RSD I don't think it's what I have. It's possible, but it seems like RSD progresses faster and has more pronounced symptoms. My symptoms are similar, but not as extreme. No excessive hair/nail growth either.

However, distal Plantar Fasciitis is a possibility. So back to the original question. Is there a diagnostic test that I can have done to show what's happening in my feet? Or prove that they are fine and it's something systemic? I don't want to take the risk of shots/surgery if there really isn't a neuroma at all.

Re: Diagnostics to discern reason for forefoot pain

Dr. David S. Wander on 2/06/04 at 17:49 (143818)


I don't think that you have RSD and I personally feel that RSD is often over-diagnosed. As per my recommendation to have blood tests done, apparently you have and did have a positive HLAB27. This could certainly be at least partially contributing to your pain. You should give the medication time to work and also understand that the arthritic disorders that exist with a postivie HLAB27 are not cured with medication. The medication simply relieves symptoms and some pain may still exist or recur. An MRI is still the gold standard to determine soft tissue pathologyu, though diagnostic ultrasound can certainly be helpful if you have a radiologist in your area that is very well versed in this modality. Ultrasound allows for 'real time' imaging, which means it can actually be used to watch the muscles in motion.