Dear Dr. Blake,
I have had a severe foot pain for many years that I cannot understand. The pain is located on the bottom of my foot, in between the first and second toe area, next to the joint of the big toe. Can you look at my xray image and tell me if you see anything that might be causing it? I'm concerned that a piece of bone has broken off of my large toe, underneath, and it isn't being detected because the x-ray is taken from the top, as best as I can tell. Also, can you explain what the white circle on the right of the big toe in the xray is?
I'm sending the other view in the next email.
Thank you very much for your help.
Dear Margaret (name changed),
There are 2 very obvious possibilities, and probable a dozen of other ones. Pain between the first and second joints can be caused by the big toe sliding off of the joint laterally (towards the second) which is happening with you. I placed the pointer on the part of the base of the toe that is actually off the joint. You can see where the normal part of the first metatarsal head ends (the white strong part). You have a 2 mm subluxation of the toe on the metatarsal. If I placed your knee cap 2 mm out of its normal groove with the femur and had you move your knee, it would start to hurt very badly. You can check the blog on how to tape the big toe medially (bunion taping with kinesiotape or 3M Nexcare tape). Tape the toe over for a week and also use a medium gel toe separator (found in bunion posts) and see if you can see any relief. I do not see any bone spurs or chips.
The second reason is that the 2nd toe is subluxing toward the 1st toe. This happens alot with long 2nd metatarsals. See how the second toe sits on the 2nd metatarsal, and compare to how the 3rd toe sits on the third metatarsal. The 3rd joint is straighter, the 2nd toe looks like (and is) leaning over to the first toe. This again can give you pain in that area. Tape the 2nd toe to the 3rd and 4th for a week with 1 inch tape. See if that eases some of the intensity.
I am very impressed on how white the 2nd toe is, but it could be just my copy. Whiteness on bone means stress. The second metatarsal should be whiter than the 2nd toe, since it handles more weight bearing. In your case, the toe is whiter than the metatarsal. Something is rotten in Denmark.
Another common structure in that area is the deep peroneal nerve. It can get irritated by the above mechanical problems, or other causes of stress like over pronation and some weight bearing repetitive stress like high heels or elliptical. The nerve can actually be irritated at your back around discs L4L5. Is the quality of your symptoms nervy--burning, tingling, electrical, buzzing, etc?
Since you have had severe pain, have you been able to get an MRI? That would probably help us immensely. Any other clues you can email me I will attach later to this post. Everyone is curious at helping you. I hope this helps some. Rich At least tell me what helps the pain temporarily and what definitely bothers it. Thanks
Wow!! You were very lucky! The white circle is called a sesamoid bone and it is normal. You could have injured it or the ligaments under the big toe joint in your accident. Look up a condition called Turf Toe to get an idea. There are a myriad on structures that could be injured and give you these symptoms. The X-ray below is called a Plantar Axial. You should get that, and an MRI, or at least the plantar axial. It will show if any structures under the big toe joint are injured. Here is an example.