tag:blogger.com,1999:blog-673715911736059911.post6721215890060962628..comments2024-03-28T02:42:33.170-07:00Comments on Foot and Ankle Problems By Dr. Richard Blake: Big Toe Injury from Fall: Email AdviceUnknownnoreply@blogger.comBlogger2125tag:blogger.com,1999:blog-673715911736059911.post-80509941441275152132017-06-29T19:20:24.557-07:002017-06-29T19:20:24.557-07:00p.s. Everyone reading this blog...please contribut...p.s. Everyone reading this blog...please contribute a few bucks! This is the only site think I've EVER seen where a doctor takes time to educate non-doctors on specific cases, and give impressions and advice. We want him to stick around and keep helping lots of people get back on our feet!Sesamoid/CRPS patientnoreply@blogger.comtag:blogger.com,1999:blog-673715911736059911.post-21728559983716661412017-06-29T19:19:06.367-07:002017-06-29T19:19:06.367-07:00Oh my gosh you are wonderful beyond words!!! I was...Oh my gosh you are wonderful beyond words!!! I was so excited and heartened to see your thoughtful responses here, and will take your advice. I can't tell you how much it helps to have your impressions. If you can stand an addendum to the (already-long) story:<br /><br />I wasn't clear, I should clarify that I CAN now maintain 0-2 pain level easily and pretty consistently while in the boot (aside from the inflexible, locked-up feeling of being encased in the @!#! thing…). It's trying to "wean" OUT of the boot with shoes/orthotics when the sesamoid and ball area gets unhappy. So crutches sound like they might be overkill, right?<br /> <br />I never had the "classic" CRPS symptom of allodynia (pain even with gentle touch. For those who think they might have CRPS, don’t let a doctor tell you you "can't have it" because you don't meet this or that "requirement." Every case is different). I’m already on a fat dose of gabapentin, which works fairly well for the burning nerve pain--not perfect, but it helps a lot and I’m almost never in discomfort when not weightbearing. However, weightbearing in shoes sets off the deep, aching pain (mostly centered in the 1st MTP joint area). That pain feels like it's "mechanical" more so than nerve-y (as a CRPS veteran I feel I can often tell the difference, but it does kind of mix together here! No doubt there is still some CRPS nerve-sensitivity in the whole region that's contributing, as you rightly indicate). So for those of us with lingering CRPS symptoms AND a soft/hard tissue injury, it's kind of hard to know what level of pain with weightbearing is actually safe; it complicates trying to stay at the "0-2" target range if one isn't sure what portion of pain is neuropathic (not gonna damage anything to walk on) vs nociceptive (could do more damage to walk on). <br /><br />Turf Toe possibility: <br />Oh dear--I would have thought this'd be noted on MRI, or my current DPM would have thought of this (he seems competent, just overloaded with patients and not as experienced with sesamoids as yourself). From the details of my last report: "There is no edema along the intersesamoid ligament.There is no femoral head collapse. There is trace fluid within the first MTP joint. The medial and lateral collateral ligaments at the first MTP joint are intact. The plantar plate is intact." Does this sound like TT could still be possible? In the first 2 months, I had problems actively flexing the farthest tip of my big toe downward, and I also had more pain in the big toe itself in the boot. Now, though, I have good flexibility of the big toe and no pain with flexion or dorsiflexion. I stretch the toes against the floor several times a day. My big toe (toe itself) does not really hurt as much anymore after a lot of walking in the boot, but could that actually be turf toe as you suggest?<br /><br />CT scans, next steps:<br />I'm glad you think it's unlikely that necrosis will happen, given all that I'm now doing. Do you think I should ask for CT scan now, or wait a few months to see how things go? The last MRI was only a few weeks ago--would there be any value in getting the CT this soon? <br /><br />"Try to work with Antiinflammatories, etc…."<br />Should I think about taking NSAIDs, do you mean? I've largely been staying away from ibuprofen b/c I wasn't sure if it was good for the bone healing. I asked my DPM if he thought NSAIDs would help with marrow edema, and he said he didn't know (honesty always appreciated!) Do you think it would help?<br /><br />I really appreciate the name of that DC doc; judging by his webpage he sounds awesome! I will get my ducks in row with going to see him soon for an outside looksee.<br /><br />That is all--no more questions. <br />A MILLION THANKS!<br />The sesamoid/CRPS patientnoreply@blogger.com