Question
I've had pain on the bottom of my left foot for 6 months now.  It seems to be located almost perfectly on my 3rd metatarsal at the ball of my foot.  I suspect that it started because of poor running shoes.  I was running close to 30 miles per week and was deployed during a time when I should have replaced my shoes and didn't.  I have stopped running and the pain is such that I haven't been able to resume yet.  The injury had occurred previously, but always resolved itself within a couple days.  I have had both x-rays and a bone scan done, but both within a few weeks of the onset of injury and none since.  Results indicated uptake, but not deemed enough so as to indicate a stress fracture.  NSAIDs seem to have some limited success with pain management, but they are not consistent.  My foot is very slightly swollen near the toe, and now the third toe appears slightly bent at the 2nd joint.  (No pain in the toe itself, though.)  From the x-rays, one doctor believed that he noticed a previous stress fracture that had since healed.  I work for a Dr in the military, so diagnostic imaging or further testing is fairly easy to get done, but our podiatry department seems unimpressed and my Dr is baffled.  We have tried custom shoe inserts, and most recently a steroid injection - no relief from either.  Podiatry placed me in a cast - but due to deployment I cut it off within 48 hours.  I am almost ready to try the cast again to see if that gives me any relief.  I have avoided strenuous exercise for almost 6 months now and am getting extremely impatient.  Are there any other tests that can be run to establish a definitive diagnosis?  Thanks for your time and any ideas that might help.

Answer
Hi Matt,

I would highly recommend an MRI.  This will be better imaging for a stress fracture and any soft tissue abnormality which may include an enlarged nerve or neuroma, inflamed joint or a torn or injured tendon or ligament.  Hopefully you will get more information and then the treatment can be more specific.  

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com

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