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Saturday, December 15, 2018

Nerve Pain in the foot: Email Advice

Dear Dr. Richard,
I am miserable an in need of urgent help.

I am a 37 year old female. I fractured my right foot (Jones fracture) on August 24 2018. I was put in a cam boot and after one month started initial weight bearing with the boot and then on the 8 week mark when the x-ray showed that the fracture has healed I was told to get out of the boot and start walking.

Several days after I started walking, I developed severe pain on the top of my foot (between the 3rd and 4th metatarsals) that made me limp badly and also on the ball of my foot that I could feel the most when walking barefoot. I went to see a foot and ankle specialist who suspected a stress fracture. He asked for an MRI and an ultrasound and both showed  no stress fractures. They also did not show any soft tissue issues, neuroma, etc. 
Dr. Blake's comment: This would appear then to be nerve irritation since it is never seen on x-ray, ultrasound, or MRI like bone or soft tissue injuries would be seen. 

The doctor gave me non steroidal anti-inflammatory (600 mg) one pill a day for 20 days and he asked me to rest my foot. This kind of got rid of the dorsal pain but the pain in the ball of my foot remains severe.

The pain cannot be felt if I touch my foot neither from the top or if I touch the ball. It is not there when I’m resting either but it shoots up when I walk or bear weight. It is the worst when I walk barefoot and when the foot spreads. 

I went to see the doctor again and he tested for neuroma but there was no click. He couldn’t figure out what it is but he says he suspects a soft tissue inflammation. He gave me two steroid shots in the areas shown in picture 1 below. He targeted those areas because this is where I thought the pain generates from. It has been a week and the shots did not help at all. I still have severe pain in my foot. Picture two below demonstrates where the general area of my pain is. And as mentioned, it is the worst when the foot spreads.
Please help I am very desperate as I have not really been walking since my fracture and I am becoming severely depressed. I was an active person before this and now I cannot even go to the toilet without having severe foot pain.
All the best,
Dr. Blake's comment: This has to be nerve irritation which will not show up on tests, but since nerves are super highways to the pain, they can give the most severe pain. Neuromas are long developing problems at the nerve, so I would not expect this to be one. You and your doctor need to find the nerve that is causing the pain with using only long acting local anesthetic, not cortisone at least until you find it. Then a treatment pain can be designed. See my post below on these diagnostic tests. You will be fine, so hang in there. You have ruled out major problems, so a local very painful pinched nerve should be the cause of this pain. Keep me in the loop. Rich
PS. The pain can be coming from above your foot also due to limping for awhile and upsetting the delicate balance of your body. See my video on foot pain from back causes.


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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.