Question
Dr:  I woke up one morning with a very swollen and painful left foot-this was 4 weeks ago.  No accident that I know of but I did wear a tighter pair of high heels?  I still have a great deal of pitting edema from my toes up towards my knee-with slight improvement over the 4 weeks.  There is pain on top of my foot when you press on the 2, 3, and 4th metatarsals and joints.  I had an xray was which negative as well as an MRI that showed EXTENSIVE edema. Ultrasound was negative for DVT.  I did severely injure the same leg up by the knee exactly one year ago but that has healed (an atv handle bar went through my leg behind my knee).  The OS was at a loss and sent me to a general MD is at a loss as well.  So I am stuck with a swollen left foot with pain when pressed on.  The edema when milked appears to be like sludge (will stay where it is pushed and I am unable to pinch the skin up by the toes because it is so tight.  Im in my mid 30's and otherwise healthy.  I'm not on any medications.  Any help or advice would be appeciated.  

Answer
I would still consider several areas. You may have a stress fracture which was missed.  Healing will not show on x-ray for weeks and sometimes the MRI slices are not thin enough to catch the problem.  So, a repeat x-ray and perhaps a Triphasic bone scan would catch a stress fracture.

It may also just be overuse from the heels and the inflammed tissues are slow to heal.  You may benefit from some immobilization and ice.

Other possibilities include Gout.  I would see about having your blood drawn to see if the chemical known as uric acid is high.

I would see a Podiatrist to reevaluate these problems. We are the foot experts and you will likely get an answer.

As a last resort, a Rheumatologist could check for autoimmune diseases, arthritis or other causes of inflammation.

Feel free to send more questions as you see other Drs.

Good Luck.

Sincerely,

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