Question
Hello.  I'm 38 years old.  I am historically a runner, including sprinting on pavement from time to time.  Last August and September, I sprinted most days (maybe 45 days out of 60).

I mention the running part because it definitely seems worth mentioning.....

around October 10th, I started feeling pain in my right foot.  It has persisted for 8 months now (seems like forever).  My leading candidate is arthritis of the MTP joint.  I had a cortisone shot in that joint 2 weeks ago.

Also recently, the other foot (left foot) started similar but weaker symptoms.  The symptoms:  pain, and just pain.  No swelling, no tingling.  But the pain is sometimes in the top of the foot, sometimes in the big toes, sometimes seemingly in other toes.  Definitely NOT the bottom of the foot.  Again, I'm not 100% sure it's arthritis of the 2 MTP joints, but it could be.  The pain definitely seems kind of diffuse and moves around.  Even after the cortisone shot, pain persists to some degree (although I think it helped).  Sometimes the big toe aches, sometimes it seems more midfoot.  The pain is never excrutiating, but always annoying.  I have it more days than not. Again, sometimes the tips of both big toes ache.

Range of motion in both MTP joints is great.  Doesn't really hurt when I move big toes through full range of motion.   I almost WANT it to be MTP joint arthritis so I have a diagnosis.  Can such arthritis (granted, early) cause very diffuse/spread-out pain ?  Seems like it would really hurt at the specific location (the joint itself).

Doesn't really hurt during exercise.   Hurts in the morning, hurts at night.  Pain seems to come after a long walk (not during, really).  Indeed, hurts after exercise, not during.

That was long-winded but hopefully I've covered all the initial round of questions.

MTP joint arthritis ?  Some crazy chronic tendonitis ?  Early rheumatoid arthritis ?  Some other autoimmune process ?  Those are my thoughts.  I've tried to play the role of doctor, but I'm just not sure what's going on.  Thank you.

Answer
Hi John,

You mentioned arthritis.  However, you have good joint motion and there is no pain with motion, correct?  Some of the other possible causes may be tendinitis or inflamed nerves to the toes.  This may be due to overuse but could also be some sort of inflammatory condition of the joint.

It may be as simple as getting new shoes and a pair of custom arch supports.  I would consider that as well.

I'm assuming that you've had x-rays.  What do they show?  I would consider a consult with a Rheumatologist or a Podiatrist that understands proper blood testing for possible autoimmune syndromes.  Also, possible consideration for an MRI.

The bottom line is that you need to find a Dr. that can look beyond just the symptom and be able to find the cause.  A cortisone injection is a Band-Aid and not a solution.  So, seek other opinions.

Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
www.thetampapodiatrist.com
www.tampacryosurgery.com
www.fix-my-foot.com

DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.