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Sunday, December 16, 2018

Metatarsal Pain: Email Advice

Dear Dr. Blake,

I am so grateful I found your blog a month ago after suffering strange left foot problems for over a year!

In August 2017 I unexpectedly was taking care of my 84 yr old mother-in-law (stroke victim) who lives on 20 acres in the country with the clothes on my back and a pair of cheap flip flops for a week. Of course, I developed Plantar Fasciitis in my left foot - wearing non-supportive shoes all day long!

Fast forward, I had 2 visits to my family doctor (who gave me steroid pills, told me to ice 3x daily and do foot exercises), saw a Podiatrist (who saw me 10 minutes, barely touched my foot for $330, gave me an injection and suggested orthotic inserts for $450) and then I saw my Chiropractor, who adjusted my foot, did x-rays (they were normal but I have a heel spur) and made me orthotic inserts for $250. 

After wearing the Chiro orthotic devices for one month, I developed additional forefoot pain but the heel pain subsided greatly. I removed those inserts because it appeared they were the cause of my forefoot pain. Immediately, the forefoot pain was less, but the heel pain came back strongly within one day of not wearing the inserts. Upon my examination, it appeared the arch was too high in the Chiro orthotic inserts, so I went back to the Podiatrist in June 2018 and got the $450 hard plastic 3/4 custom inserts which had a definite lower arch.

I continued to wear the hard custom orthotic inserts and my heel pain completely subsided but the forefoot pain got worse. So I bought a variety of OTC inserts trying to find a solution. I went back to my family doctor who told me I have a mechanical problem, gave me steroid pills and told me to stay off my feet and do contrast therapy. I don't want to keep doing steroids! At that time, I averaged 9 k to 13 k steps a day because I am very active person, so now I have cut back to 6 k-8 k steps daily and try to rest my foot.

After reading several sections of your blog, I have determined I have 2nd metatarsal capsulitis, with beginning hammertoes on digits 2, 3, 4 and a definite Bunion, stage 2-3 on my left foot. I have lost strength in my left foot since June 2018. I can barely spread my toes now and the hallux joint seems 'lax' and does poorly with resistance testing when trying to dorsi-flex the toe. I bought shoes with bigger toe boxes. I bought some Yoga toes but I haven't used much since they hurt my smaller toes. I also have Stage 2 bunion on my right foot, but no issues other than my right foot gets overloaded from compensating for the left foot!
Dr. Blake's comment: Try cutting off the part of the Yoga Toes to the 4th and 5th toes. 

Without actually examining me personally, (I live in Texas), can you at least give me general advice on what I am doing currently? I am attaching a picture of my foot and insert.

I am taping the second digit and sometimes the third digit per your video instructions. This seems to be helping. I am icing the ball of foot 3 times daily for 15-20 minutes. I am doing the alphabet with my foot and rolling my arch on a tennis ball every morning. I am doing your doming exercise 2-3 times daily (10-12 reps) with both feet and place my sock rolled up between Hallux and 2nd digit space to 'straighten' the toe. I have placed a homemade MT pad using felt from Hobby Lobby taped to my insert (I couldn't find anything in stores - I was desperate to relieve the pain!).
Dr. Blake's comment: If you feel better after the icing, continue. If you do not feel better, it may be too long, so reduce the icing to 5-10 minutes. 

Q 1. I notice that after awhile, I will have pain/cramping in the lateral side of my foot (5th MT) even though the 'pebble sensation' in 2nd MT is reduced greatly by the pad and topside swelling has gone down. Yay! Is this pain caused by 'loading pressure' from the arch in the orthotic support? Or from the MT pad? Or both? It seems like one thing fixes one issue, but then causes another issues. Any Ideas? Solutions? So far I am continuing with the pad and dealing with the lateral pain.
Dr. Blake's comment: Yes, probably from orthotic devices, limping, etc. Try to alternate what you have on your foot several times a daily, one being no orthotic devices. 

Q 2. Is it okay to do the doming exercises while dealing with the capsulitis? Will the doming exercises strengthen my Hallux? Any suggestions for getting back strength in that big toe and all my toes of left foot? I continue to try and spread the toes and I also flex the toes after doing the alphabet.
Dr. Blake's comment: As soon as you can do single leg balancing, see the cut out I prescribe for sesamoids so you can do the same idea and float any sore area, you will really start to strengthen your foot and toes. 

Q 3. I tried the gel toe separators for my bunions - they hurt a lot inside my shoe-seemed too hard/big. Suggestions for alternatives and how important is it that technique for me?
Dr. Blake's comment: Not appropriate now while you are dealing with the capsulitis 2nd, too much pressure on the 2nd toe. 

Q 4. Use the Yoga Toes less time until they don't cause pain in the smaller toes?
Dr. Blake's comment: Try my technique for cutting the part that separates the 3rd and 4th toes, and separates the 4th and 5th toes. If still painful, try the less intense Yoga Gems. 

Thank you again for reading and answering my email. I was going to donate to your blog and when the site asked me my address, it stated something about contacting you regarding your privacy practices about my address. Can you tell me those or where you have them posted so I can donate with comfort? Thank you again.
Dr. Blake's comment: Thank you for the gesture. That must be a new Pay Pal privacy rule. Your email is never shared with anyone by me. 

Further comments: It is not unusual for a patient to hurt their heal, limp, and then hurt the front of the foot. The inserts, could have been made by anyone, custom or over the counter, probably had a hard spot right under the 2nd metatarsal that bruised the soft tissue. 5 minutes of ice massage is better than just sitting on an ice pack if you know the sport. I have a video on protecting a sore spot that may help you. I do have to say how proud I am of how you are attacking this problem and quite logically. Keep me in the loop. Rich

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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.