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Wednesday, September 3, 2014

Forefoot Pain: Sesamoid or Nerve or Both

Hey Dr Blake, 

Through my despair yesterday I stumbled upon your blog and I must say I am so glad I did. I really wanted to e-mail you though, I hope you don't mind.

I'm a 23 year old female who hurt my foot 3 years ago! I literally stubbed the inside edge of my foot, just half an inch under my first metatarsal head. I never got an X-Ray but I was in agony for about 3 months, my local doctor told me it was just a "BAD bone bruise". If say the pain dissipated about half a year down the line and slowly but surely I got back into my fitness which I loved so dearly. 

For these 3 years pain in my big toe joint had been on and off, the pain itself is felt at the base of the head, sometimes on top but mostly behind but at the outer edge (there it is like a niggly/twingy pain that gets worse with activity) I get pain whenever my toe joint is in a bending push off position..and it ALWAYS clicks, that's recently got worse.
Dr Blake's comment: The niggly pain is nerve, as the biggest nerve in the front of your foot runs right there. It can develop into a condition called "Joplin's neuroma", but the nerve can be irritated and angry from simple internal swelling. The clicking means that there is swelling within the big toe joint, signifying some problem in that joint. 

I saw a private podiatrist about 2 years ago now who got me into Orthotics as she noticed I pronate and had "flexible flat feet". She disposed (diagnosed) me with Hallux Limitus. These helped somewhat, a lot.
Pain would go away for a couple months only to come back if I increased my activity or wore heels then I'd suffer with the pain and swelling for another month. 
Dr Blake's comment: Hallux Limitus is caused by many conditions, and you seem to have a very sensitive big toe joint. X-rays and MRIs are usually needed to help discover what you did to yourself 3 years ago. 

I went to see my doctor who thinks it's a sesamoid issue, so I get my X-Ray results on Fri. My podiatrist recently gave me acupuncture which kind of helped but I found the procedure painful. She also said I should go back in a month and we'll talk about seeing an Orthopaedic for a surgical outlook and also a steroid injection.
Dr Blake's comment: This is all right except I would avoid invasive (even shots) until I knew the diagnosis. Let me know what the x rays showed. 

My arches are also so tight and when I do strengthening exercises it hurts alot. The toe joint is really swollen, mostly on top but icing makes it so much worse, specifically that niggly feeling on the edge underneath, which makes me worry that it is a sesamoid issue. 
Dr Blake's comment: Nerves typically hate ice, so try some version of contrast bathing (see previous posts). Icing typically cools the joint, but does not move swelling out of an area like contrast bathing. Where the initial contact was sounds sesamoid. See if you can get the results of the x-rays to me, and possibly get an MRI. 

I'm just at my wits end because I'm so young and meant to be starting uni this year but exercise means, namely walking, but it hurts too much now and I seem to be compensating with my other foot and my other toes, I would swim but it flares up my acne and also makes my feet too cold which makes my toe sore.

Any advice would be grateful,

Sara (name changed to protect the innocence)

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.