Weird foot thing: any theories?

I see you put in your topic list “diabetes”. Are you diabetic?

By any chance, are the third or fourth toes involved?

Based on the info alone that you have given the top two things to consider are

1) Neuroma (due to anatomical considerations, most commonly occurs between the 3rd and 4th toes, altough can happen elsewhere….)

and a distant second
2) Diabetic neuropathy

or a combo of both of the above….

I would probably check out acupuncture if you are already checking the normal things related to diabetes through a traditional doctor.

Acupuncture is all about identifying and correcting the flow of energy through the body. That would be my next visit before going to a nerve specialist who would might consider surgery.

@Snoopy, yes, I am, which is why my doc looked first for any indication of neuropathy and concluded it was negative.

Yes, third toe. At first I wasn’t sure if it was third or fourth, and then it seemed to center in the third. Hmm, that’s telling, isn’t it?

So what kind of doctor should I consult?

@Jeruba a podiatrist….

Start googling “Morton’s neuroma” and you will likely find more info than you could possibly want to know….

It is very common.

Keep in mind that a nerve is irritated, getting squashed. It could be irritated b/c the bones on either side are pinching it or that the nerve has enlarged (most likely a benign growth) and is bumping up against the bones. Or both.

In any event, you will want to give the nerve as wide a berth as possible to decrease irritation. You will be able to find a multitude of suggestions….however, the most useful will be to obtain wide, non binding shoes, using NSAIDS as needed, decreasing activity and icing as needed.

If unable to keep the area in check, a cortisone shot (or a series of them) to the area can be of great benefit.

If, after exhausting all conservative treatment, you are still in a signifcant amount of pain, surgical excision of the offending nerve may be warranted.

@Snoopy, thank you, thank you. Are you a medical practitioner of some kind? I thought I remembered reading that you are a nurse, but it’s not in your profile if so.

I am already taking pain meds for my back. Previously I had plantar fasciitis, which cleared up after about a year, and I pretty much abandoned uncomfortable shoes then, except for the occasional dressy event (when I try to stay seated as much as possible). I lost my confidence in cortisone shots after several for lumbar pain had no effect at all and one for (spinal) cervical pain caused nerve damage that left me with strange headaches from that day to this.

Thank you for your comments, @fireside. I think I need to consider traditional avenues first, but I will keep acupuncture in mind. By now so many things hurt all over that I think I would need the full porcupine works if I ever tried it.

@Jeruba Generally I’m pretty skeptical of non-traditional medicine, but in terms of pain-management, acupuncture has really helped me.

Yet another real possibility is tarsal tunnel syndrome. This is similar to carpal tunnel syndrome, but occurring in the ankle rather than the wrist. Plantar fasciitis, which you said you had, can often be confused with this disease. I suggest a repeat evaluation by your (new) doctor, focusing on causes of peripheral neuropathy. Good luck.

Thank you very much, @shilolo. I have kind of been on the alert for tarsal tunnel. I have had carpal tunnel release surgery in both hands. But would it manifest in only one spot, one toe?

My new PCP is an internist. It seems to me that heading to a podiatrist would start me in one whole series of explorations and to a neurologist would send me in another, and I really want to take the course that is likely to get me to the goal fastest to minimize appointments. I put this off because those long series of appointments, half-measures, rechecks, referrals, etc., as I have already had with knee and spine, are so incredibly time-consuming and make me look bad at work at a time when my job is in jeopardy (and I have a new, not-understanding manager). I was hoping someone who responded here might help me zero in. Do you think I really have to start with my PCP (not required by my insurance), or should I start with the foot guy or the nerve guy?

Thanks for the testimonial, @andrew. I am afraid I’m still working on overcoming my prejudices.

@Jeruba If you feel you are having multiple nerve issues, I would see a neurologist. The downside would be if you need surgery, then you are starting over again…

If your primary concern is the foot, then I would see the podiatrist. The downside would be that he/she will focus primarily on the foot…and refer you elsewhere if it is apparent that the scope of your problem exceeds those anatomical boundaries.

In either case, I would get a recommendation as to a specific name of said specialist from your internist. Your internist should have a handle on who the best docs in your area are…..

Again, based on the limited foci of pain (third, maybe 4th digit) the highest index of suspicion would be for Morton’s neuorma—->podiatrist.

Best wishes.

I think a cortisone shot sounds good too. It may be hard to keep the nerve from becoming irritated again. Good luck!

I agree with snoopy. From my experience working in a podiatric office in the past 6 years, your symptoms sound like morton’s neuroma, or possibly even a stress fracture (doubtful). As shi mentions, tarsal tunnel syndrome would produce symptoms in the ankle.

I think your best bet is to see a podiatrist. As a diabetic, you will need to check in with one from time to time anyway, and now is as good as any other time to start. You may benefit from a cortsone injection and maybe a good orthotic may help you avoid surgery. I hope you find a good doctor and get some relief soon.

Thanks, @scamp! Sounds like convergence on podiatrist. I’ll start there. You guys are great! I am really grateful for all the kind interest and helpful suggestions.

I learned after knee surgery that the link between independence and mobility is far more significant than I had ever contemplated before. There is virtually no independence without mobility. We tend not to think about it at all—just take it for granted!—until it is compromised.

If you want to save a little time, you might want to ask you family doctor to send you for an MRI before you go, so on your first visit, you could have the podiatrist go over the films/results with you.

Your insurance company may require prior authorization for an MRI, and may deny it if no x-ray was done first. If this happens tell your doctor’s office to tell them that they are looking for Morton’s neuroma, which cannot be seen on x-ray. (Only bone is seen, not nerve on x-rays) Hopefully, that will help you skip a few steps and get you closer to a diagnosis and relief!!

Also an MRI will help to visualize a small stress fracture that a regular xray may miss in case that is what is troubling you.

I disagree about starting with a podiatrist, frankly. You have a peripheral neuropathy, plain and simple. A neurologist would be able to manage the diagnostic aspect, and therapy if it is a systemic issue. If it is a local issue (a neuroma, fracture, tarsal tunnel, etc.), then a podiatrist could help.

Also, it wasn’t clear to me that you have diabetes. Is that true? If so, it opens up a whole other differential of possibilities, including diabetic neuropathy and osteomyelitis of the metatarsal.

@shilolo really? Even tho she has classic morton’s nueroma symptoms? She would need to see a podiatrist periodically anyway since she is diabetic, so why not start there? Since the pain seems to be localized around the 3rd and 4th met area, I would think a podiatrist is the best place to start. They could rule out neuroma or stress fracture and treat nueropathy if it is only in the foot, and turf her out if it is beyond their scope.

Maybe getting the MRI and going over the results with her family doctor would help her doctor decide where she should start. Do you agree with this?

I’m curious…could she have osteomyelitis without an injury? I don’t remember her mentioning one.

No injury. It just started to feel weird while I was sitting in the departure lounge at United Airlines, after dashing around for about two hours packing.

Well, osteomyelitis can occur via several mechanisms, including local trauma but also blood born spread. You are right that most commonly in diabetics there is an overlying ulcer, but sometimes minor trauma seeds the bone, and then that is all you need for an infection to set in.

Thanks for explaining that shi. An MRI should show this as well, do you agree?

@Jeruba shi brings up some very good reasons for you to have at least yearly check ups with a podiatrist that specializes in diabetic foot care. Diabetics typically lose sensation in their feet due to the damage diabetes can do to small blood vessels, so a small injury may go undetected and can turn into a big problem. It’s a good idea to learn how to inspect your feet regularly with a mirror. (Your doctor can show you how to do this and what to look for.)

Whatever the outcome of the problem you discusss in this thread, you should learn how to take care of your feet so you avoid ulcers and other problems which can get out of hand quickly and be quite dificult to heal due to circulation problems. If I had time, I’d find some links for you to look at, but I am working now, and Mondays are horribly busy.

Are you a smoker? Not to get personal. A combination of bad circulation and poor footwear could be the cause of you problem. If it is not diabetes.

I quit smoking nearly 20 years ago. And I do wear decent, comfortable shoes with good support. (But I slop around in slippers whenever I am at home.)

I’m sorry. I meant shoes that were too tight. I have recurring pain/numbness in 2nd and 3rd toe that feels exactly the way you described. My big toe on the other foot used to do it but now it is just slightly numb.

Update 1/15/09: All by himself and without any prompting from me, the podiatrist diagnosed Morton’s neuroma and proceeded to prove it by pressing in a certain spot that made me yike.

Cortisone shot administered on the spot (currently numb). Orthotics measured for and installed. Probably no need for any surgery, he says. It’s not doing any damage; it just hurts.

Also passed my diabetic foot exam with flying colors. Missed one tickle.

You folks were all wonderfully helpful, especially Snoopy and Scamp, who called it right on the nose (so to speak). You two, I’ve probably already lurved you out, but if you post a note below, I’ll try to give you another boost.