At the risk of being too late to the party, I'd offer the following:

It sounds like you have a 2nd MTP joint plantar plate tear in conjunction with a gastrocnemius equinus contracture. Also I would bet you have what it called a "Morton's foot" in which the 2nd metatarsal is congenitally lengthened leading to overload conditions at the 2nd MTP resulting in this type of pain. I often see these misdiagnosed as neuromas...

Interestingly, your plantar fascia problems are probably related to the contracture as well. It often overloads the foot first and stresses the fascia, then progresses down towards the MTP joints. These issues can sometimes be addressed surgically by gastrocmenius resection combined with a Weil shortening metatarsal osteotomy.

I hope you are healing and it's not too little info too late.


Orthodoc

XLR8SportsMed.com

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xlr8sportsmed.com

x 100 (though this is almost 1 year old). Can't believe someone that the original poster has seen has not investigated this (though his MRI did not reveal a plantar plate tear, though they are missed there as well of course). With the couple of steroid injections he had, there might be a tear now :(

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Wow its been a long time since I've been on here. I guess an update is in store.

As I said a ways back at one point I went on crutches for almost 4 weeks to have the pain quickly return and was truly left with what felt like nowhere left to turn. I think I just ended up accepting that I wasn't going to bike/swim/run for any length of time and stopped doing all 3. I still climbed as long as I could manage the pain but that was it.

Regardless of my foot condition I planned a summer road trip of climbing and hiking across the country hoping my foot could handle it. I got a PRP shot in my foot in late June. Holy f-ing balls that hurt. I can handle some serious pain, I tried to walk off 5 broken mt's in my left foot at one point, but damn that hurt. I could literally feel the fluid squeezing between tissues and between my fat pad and muscles in my foot. It felt like molten lava being forced into my foot. Either way I was given the shot immediately before driving across country on my roadtrip. From Jun. 18-Aug. 18 I climbed and hiked and climbed and hiked(El Cap, Half Dome, Mt. Whitney, Grand Teton, JMT, lets just say it was a hell of a summer). My foot hurt every day but it was manageable with Aleve and daily elevation.

I came back and my foot got worse when I started to bike in September. I went back to the doc and got another MRI. He told me it turns out I wasn't crazy, there is something wrong with my foot after all....they just don't know what! The MRI found fluid and swelling in and around the 2nd and 3rd MTP joints but still didnt know why. No plantar plate tear, no soft tissues injuries noticeable, just fluid and swelling that apparently to them had no reason to be there. Doc suggested elevation and deep tissue massage as a last resort not knowing the next step to take.

And well, it may have helped. For the next month I slept with my feet raised on pillows and dug very very deep with massages and it seemed to slowly diminish. That was about 4 months ago. I am finally SBR-ing again, though my runs are literally about 20 mins long every 3rd day. But I've learned my lesson, I'm not gonna push it and I am beyond ecstatic to be almost completely pain free 2 years after my injury with all that I went through with it. It still begins to throb a bit after wearing tight shoes and running too much, but it is worlds away from what it was.

I've heard soft tissue can take up to 2 years to heal on its own. My doc and I surmise that I tore something in my foot that just wasn't showing up on the MRI and was taking forever to heal due to the fact that I am very active and you cant exactly rest a foot very well. I guess I'll never know.

It definitely wasn't porokeratosis, though thank you for the thought. My foot has a high arch that doesn't collapse. The one thing that I have always wondered though, both of my feet have always had toes that are very straight and in line. After this injury my left foot still looks that way but on my right foot my 2nd toe has a definite droop to it. Interesting to me.

Groundbreaking, really. When injured, stop stressing the area, and rest. Don't know why it took you 2 years to figure that one out. Happy you got out of this one though. Happy SBR.

You clearly didn't read everything. I took LOTS of rest including total time of 8 weeks in a boot, 4 weeks on crutches, and many other periods of rest where I did zero activities; all which did not help. Thank you for your groundbreaking instantaneous 30 second diagnosis. I think the timing of when it seemed to begin healing may have been a coincidence as it was slowly starting to feel a bit better even before the last MRI. Resting a foot injury is tough, when every step you take during the day isn't exactly rest.

I'm just coming back from something similar. I lived with it for over 5 years and although I was able to run through it with modified orthotics, I always had constant pain under my 2nd toe. I had 2 MRI's and neither showed a torn plantar plate, but did show fluid around the joint capsule. I finally had enough and went under the knife last September. The surgeon performed a bunionectomy and a 2nd MTP osteotomy to correct the biomechanical issues. However, when I woke up from surgery I had a bonus scar on the bottom of my foot. In his words, the plantar plate under my 2nd mtp was "gone." Things have healed up nicely, and the only thing that is keeping me from running more is the near record amounts of cold in the midwest.

This may have been mentioned before, (I'm not reading through all of these posts) but have you had an EMG? My husband dealt with the same issues for the past 2 years he has had a MAJOR back surgery this past September as they were hoping the pain in his feet were a result of a compressed L5-S1 he had this surgery and still no relief on his feet, he had an EMG in January. They diagnosed him with several nerves that were dying off in his feet. He just had another surgery this past Monday to have a release of the tarsal tunnel. He had the exact same symptoms, felt like he was walking on a golf ball on the ball of his foot with pain, numbness and tingling. After a couple of days he can already feel the difference after this surgery. You might want to look into that if you already haven't done so.

http://orthopedics.about.com/...s/a/tarsaltunnel.htm

This is a little of a hijack but on the same subject for rroof and orthodocdjd. I had surgery for "Mortons Foot" on my right foot a few years back and results were great, no issues afterwards. It now seems I have the same issue on the left foot. I guess my left and right foot have similar long 2nd MTP thus putting to much stress on the joint. I caught the problem on my left foot much earlier than with the right foot, and per my foot doc, have not had any cortisone shots (which would mask the issue and cause more damage). My doc (same one that fixed me before) is recommending conservative treatment for now to see if we can get it under control. Right now my running is very limited to nil because of the issue. I am able to bike and swim without problem. But even with lots of ice and rest the issue does not get much better. I am able to run for 30-40 minutes once or twice a week without too much pain. Certainly not enough to train and race competitively.

My question and problem is this -- if I am predisposition-ed for this problem shouldn't i just go ahead and have the surgery instead of wasting a year of time and money trying to manage it?

Any thoughts or advice you can provide would be appreciated.

Thanks.

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mikew

That is a tough question and you will get different answers from different specialists. I'm personally not too keen on immediate or prophylactic surgery. However, if you are certain this is the exact same problem, surgery was successful and you have access to the same surgeon, nothing wrong with "pushing" a little in your more unique situation with your physician.

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Thanks!

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mikew

I've gotten a few PM's about this so I figure I'll follow up one last time.

I was feeling really good and most of the pain was gone back in February so I decided to start doing some normal activities. I played 2 nights of indoor soccer back to back and the pain was back worse than it had been in a year. I made an appointment with a new doctor and he immediately thought it was a neuroma and was so confident he suggested surgery. I had surgery last week and he removed a neuroma between the 2nd and 3rd that was about 2 1/2 inches long and 10mm at the thickest point.

The relief is that we hopefully figured out what it was and that after I recover I'll be good to go.

The obvious question to me is how did they miss it? Well the 2nd orthopedic surgeon I saw almost 2 years ago thought it was an asymptomatic neuroma and gave me an MRI, but when it didn't show up on the MRI he discounted that and wasn't too sure what to do. I had a 2nd MRI as well over a year later but it didn't show up on that one either. According to my current doc without using contrast it wouldn't show up on an MRI. Over the course of the past 2 years I have had 3 different highly regarded docs tell me that if nothing is showing up on the MRI's then there is nothing wrong with me, that it is probably a biomechanics issue. Yeah, well F them.

On the positive I'm excited to start training again at some point and not have daily chronic pain! I'll post the pic of it later today when I get a chance.

 
http://oi57.tinypic.com/ixvy8p.jpg

How about it? Small, big, just a regular ol Neuroma?

Typical size. Length irrelevant, the perineural fibrosis is the part just behind the "Y". Interspace fat after that - good dissection out to the digital branches

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

I stumbled across this thread. Did you ever figure it out? Was anyone's foot pain issue similar to mine [Failure to diagnose 10+ years chronic heel pain right foot]

I wonder if it's from your climbing. Super cramped fit jammed in shoes. Plus, the pressure of the weight of your body on the feet, toes, ball etc.

I would get some hard core massages on your calves and maybe acupuncture, chiro etc.

Just a different approach...since you are fine in flip flops, but hurt in shoes.

I know your post is from years ago but I"m just trying to see if anyone here has found relief or results with any further testing?

I've been reading through these threads about capsulitis and metatarsalgia. Has anyone ever tried an amniotic stem cell injection to see if that would bring relief and healing? I am at wits end with all of this that started in June 2018. Wound up with a stress fracture in my 4th metatarsal and capsulitis for 4th MTP joint. The capsulitis/metatarsalgia just won't let up. I've tried different shoes, orthotics (did not feel good at all), RICE method as I was in a boot 2x and on crutches. I've done cortisone 2x in my right (1 into 3rd webspace and 1 into 4th toe joint) and it has done nothing for me. Long story short my doctors tell me they can't do much more because mri and ultrasound not showing neuroma. Ultrasound only (only is a bad word to use b/c capsulitis is a you know what!) shows capsulitis of my 3-5 MTP joints on my right side and 4-5 MTP joints in my left foot. I have a neuroma that developed in my left foot 3rd webspace as well during my right foot injury. My right is the problem foot by far. I've been trying to rehab my knee that I had scoped on 8/2/19 due to injuring it when I tried to go back to work from foot issues. My knee is doing well. my feet..mainly my right..is not. I tried to get my dr. to do an MRI w/ contrast or an arthrogram and he wouldn't do it. Any advise on stem cell injections or different imaging that should be done (ex: mri or ct w/contrast? I've done MRI, US, xrays and had a CT back in August of 2018 for my stress fracture.