Question
Three months ago, after a weekend wearing high heels, I went for a 2-mile run, and finished with some mild pain in my left big toe.  I ignored it for a week and didn't run, thinking that it would get better on its own.  It got worse to the point that I could not bear weight on it.  I went to see a podiatrist.  He took an x-ray which didn't show anything, so he assumed it was stress fracture, wrapped it in a soft cast for a week, and prescribed a hard-soled shoe.  A week later, I stared feeling a lot of pain on the ball of my left foot.  My podiatrist told me I developed a bursitis on the ball of my foot.  It was painful to the touch.  He gave me 3 cortisone injections.  After 3 months of no improvement and still not being able to walk on my left foot, I went to an orthopedic surgeon who ordered an MRI.  The MRI showed no fracture or bursitis.  He said it looked like soft tissue inflammation and possible nerve damage.  At the base of my toe where it meets my foot, there is one point where it hurts a lot if I press on it.  He said he was stumped and suggested I stay off it completely for the next two weeks.  I decided myself to use crutches (because I'm a bit desperate at this point for some improvement).  One other piece of information -- almost every night, my foot becomes hot, swollen, sometimes burning, and red. I usually ice it and elevate it. I have also been treating my foot for athlete's foot with micatin.  Most recently this week, when my foot is not kept elevated, it turns purple.  I am a generally healthy female, in my early 30's.  I'm thinking of going to see a neurologist next.  Any suggestions or insights at all would be greatly appreciated.  Thank you very much for your time!!

Answer
It's a tough one to help with without seeing you, but it seems like you may be dealing with 2 different issues.

The pain beneath your great toe can be an inflammation or fracture of your sesamoid bones, which are two small bones beneath your 1st metatarsal head.  It is often missed by MRI because of the size.  I suggest getting a bone scan.

The other issue, the discoloration, swelling, etc, seems like a different issue.  There is a condition called RSD (Reflex Sympathetic Dystrophy) that presents in a similar way.  You should visit with your podiatrist or a neurologist for that.

All the best,
Andrew Schneider, DPM

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