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Monday, June 26, 2017

Big Toe Joint Problems: Email Advice

I wanted to reach out to you as I've been using your blog so much for my injuries and I was hoping for your opinion. About 6 months ago I started to notice pain in my arch and it almost felt like more of my arch was touching the shoe than I was used to. This pain then turned into pain in my heel and ultimately, plantar fasciitis.

I ended up getting a cortisone injection in my heel which did help with the inflammation. Unfortunately, I had to walk on the ball of my foot for 2 weeks after the shot because I had a really bad cortisone flare up and the pain was excruciating. Once the pain and swelling subsided, I felt so much better. Unfortunately 2 days later I woke up with awful pain in the ball of my foot, above the sesamoid bones, almost like it was between my 1st and 2nd metatarsal. I never had much pain when the actual sesamoid bones were pressed.

I went to my podiatrist again and he diagnosed me with sesamoiditis. The pain was worse than the PF and was felt every time I took a step. I tried dancer pads but those only made my PF start to hurt more. I went back to my podiatrist again and he ended up giving me another cortisone injection, this time for the ball of my foot. The pain was worse for the first week or so as I had a viable bruise but after 9 days the bruise and pain went away.

At this point I thought I was finally done with all the pain. Now I'm experiencing a lot of pressure and stiffness in my big toe. If I stand barefoot, there's a lot of pressure at the MTP joint. I still have range of motion in my toe and it doesn't hurt to use my hand to flex the big toe up but if I make my foot dorsiflex, I feel a lot of pressure in the joint. I can actually stand barefoot for once but the pressure is just so uncomfortable. I went back to the podiatrist again and he thinks it's just the sesamoiditis causing this pain. My concern is it's arthritis developing in the 1sr MTP joint.

I'm going back to the podiatrist again tomorrow as I would at least like an xray (he never did one but I had one prior to seeing him, maybe 1 month prior and it didn't show anything) just to make sure it's not arthritis. I'm still unsure if I had sesamoiditis in the first place.

I wanted to get your thoughts if this truly does sound like sesamoiditis and can sesamoiditis cause this much stiffness and pressure in my joint now? Or does it sound like I might have something else going on in my foot? Can sesamoiditis eventually cause arthritis?
Sorry for such a long email. I've been so anxious to heal since I've been so inactive for 3 months now trying to rest my foot and we've got a 12 day trip to Germany in 2 and half weeks.
Dr Blake's comment: It sounds like when you walked on your toes abnormally (never a good idea, but definitely what we all would have done in the circumstance) you sprained the big toe joint. The feelings of a sprained joint is stiffness, pressure, some loss of motion if real bad). See my postings on how to do contrast baths to reduce the pressure, and spica taping for long walks. I would also ice the joint with a pack for 15 minutes twice daily. 

Thanks for any advice possible.

And the patient also wrote:

Dear Dr. Blake,

Recently I started to have nerve sensitivity in my left foot right where my bunion is. I never paid attention to my bunions before because they aren't that big and never bothered me. I was trying a new pair of sneakers that creased every time I walked, and rubbed my bunion. This caused a nerve sensation to develop that I feel every day now. I've been using YogaToes everyday to help stretch out my toes but would you recommend anything else to help calm down the nerve sensitivity? It's not really a pain, it's more of just an irritation but definitely gets worse when I wear shoes now. Any advice would be greatly appreciated!
Dr Blake's comment: Order some Neuro-Eze gel to massage in 3 times a day for 2 minutes. Until you get that use any type of massage oil to do the desensitizing massage. 



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  2. Thank you so much for your answer! My podiatrist gave me another cortisone injection in my big toe which didn't help at all. I was thinking it was potentially turf toe after looking at the symptoms. I will continue icing like you recommend. I recently started taping the big toe which has definitely helped with the pain and pressure.


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.