Joe A Shaw PA-C - 9/22/2008

Question
QUESTION: I started a job about a year which requires me to be on my feet for long periods of time. After standing for a few hours, my feet becomes very painful, around the 4/5 metatarsophalangeal joint. After thinking it was my shoes, I replaced them with special cushioned shoes which helped, but didn't stop symptoms. I probably should have gone to the doctors with this sooner...

Generally, the pain is a continuous ache even when sitting (worse on weight bearing.) After sitting for any period of time, it feels like my foot has 'seized up' when I try to put weight on it and is very painful. If the outside of my foot is manipulated in any way this also causes pain, as does any pressure on the outside edge of my foot. I can also crack the joint, like some folk can crack their knuckles, which I imagine isn't usual.

I can't imagine it's heal spurs, plantar fasciitis or a neuroma (pain isn't a sharp 'electric shock', area is close but not normal.

I am overweight but not terribly. Is this something I should see my regular doctor with?


ANSWER: Stuart,
Yes you need an eval either by your Dr an ortho, or DPM. You need xrays to Rule out any bone abnormalities or growths etc... May be a morton's neuroma. Could be chronic strain/sprain of the ligaments or tendons of the foot. Sounds like you tried the usual stuff..inserts, etc..but you need a further work-up at this time and possible some custom orthotics.

---------- FOLLOW-UP ----------

QUESTION: One thing that is odd that my foot is never sore when I've not been standing - only after work etc. and it can be sore the next day.

I presume any evaluation will find any problems even if I am not in pain at that moment?

Answer
Well first off I wouldn't go in with expectation that in one visit you will find out the diagnosis..it may take several visits or tests and or a referral to a specialist. You say it is never sore if you have not been standing...but then say it can be sore the next day?(so it can be sore even w/o weight-bearing?)
With it being sore after standing it sounds like something of a strain/sprain that proper orthotics may help..but xrays,exam even MRI,cortisone injection may be needed to make sure