Question
Dr. Gillman,
In June, I first injured my foot while at a wedding dance.  I rolled my foot and ankle starting with my pinky toe.  Just over a month after that, my foot still hurt, so I had x-rays taken, saw a general MD, and was referred on to a foot and ankle specialist.  The specialist said that I had injured my 2nd, 3rd, and 4th extensor tendons on my right foot.  He prescribed some pain medication and sent me on my way.  About a month later, my big toe started to hurt for no reason and had lost quite a bit of ROM.  At the time, I was coaching volleyball and had just started the school year (I'm a teacher for high needs children).  I was constantly on my feet, including weekends.  This entire time, I couldn't push off of my foot properly.  I put up with this for about 3 months before having my foot looked at again.  I went back to the same specialist and he seemed baffled to what was wrong.  He advised me to get some stiff-toed shoes and to schedule an MRI if that didn't help.  Unfortunately, the shoes did not help and my foot seemed to be getting worse.  I'm sure the extreme cold weather in my part of the country did not help!  After I was told my MRI results, I was a little baffled...my doctor said that I had a bone contusion on the ball of my foot.  Once again, he just advised me to get Shape Ups or shoes similar to them.  Could/Should I have a bone contusion 7 months later?  My doctor said that if the shoes don't help that he would prescribe physical therapy.  I have had plenty of PT for my knee and I don't really see how PT would help...Would proper chiropractic care help?  Should I get a 2nd opinion?  I am just ready to start to walk normally...
Thanks for your advice and time!
Heather

Answer
Hi Heather,

If your bones get repetitively strained, then a "contusion" will show up on MRI.  This will often be described in various ways, such as "bone marrow edema" and/or with "sclerosis" of the boney "cortex."   It is the bone's reaction to being banged around, either acutely or repetively over time.   If you wear shoe with a good molded foot bed that allows the ball of the big toe to have a lot of room (this is called a 1st ray cut out in orthotics terms), then you likely will feel better.   My only guess is that our original foot injury caused you to alter your foot mechanics in some way, and this led to the bone irritation.   As for foot orthotics, there are some generic, off-the-shelf types that are okay, inlcuding SuperFeet, PowerSteps, and ALINE. As for customs, these will vary from one provider to another.   Frankly, while I've seen, worn, and fabricated some nice podiatric style orthotics, I've been quite happy with the simplicity of Sole Supports orthotics.  They have a web site so you can find a certified provider.  

I hope this was helpful.

Dr. G