Question
Thank you for the response Doctor.
It was sorta what I expected to hear and would be happy to give you more information.
I'm 55 years old and have always been quite active. I was a jogger up until about 4 years ago when a fall, resulting in a fractured shoulder, stopped me.
Now I just power walk and exercise. It's safer!
I also bowl and am very active in my home. I'm always on the go, so to speak, so I'm on my feet a lot. In additon I work full time, and until this problem started, was in high heeled shoes 10 to 12 hours a day.
I have no health problems (thank goodness) and take no medications. I'm not over weight and there is no history of arthritis, autoimmune problems, diabetes or gout in my family.
My toe looks normal, it has never been red or swollen.
What has me baffled is that when this started, it actaully started in my left toe after walking one day, but for only one day and only one episode. That seemed to resolve itself, but the very next day it started, with the very same pain, in my right toe and four months later, while the pain is not as intense as it intially was, nor as often, I still know it's there. I really thought that I had irritated a nerve from the shoes I had been wearing because of where the pain was in both of the toes.
Also, and this may sound strange, it doesn't seem to bother me when I'm active. It's when, for example, I sit down after activity ,that it may "jolt" me, but not always. It's unpredictable when it will happen. I have no warning and done't really understand what triggers it.
I have tried to recreate the pain by bending, squeezing and twisting the toe, but that doesn't seem to trigger
anything. I have,I think, noticed that when my toe is bent backwards for a while, like when walking up a flight a stairs or squatting, it gets a "jaggy" sensation in the space between the toes.
Honestly though, at this point, I've become so aware of it, I'm not sure if that's all in my head or not.
Thank you again for your help.

Helen




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The text above is a follow-up to ...

-----Question-----
Thank you for taking my question Dr. Katz,
My problem began in August when, after power walking (3 miles daily. I am a very active individual) I received an intense shock like pain in my left big toe. That was the only pain I received in that toe and had none since, but the next day I got one in my right big toe. I have had that problem since. I went to a podiatrist who xrayed my feet, found no deformities or arthritis and advised that it was Morton's Neuroma. He gave me a cortisone injection on the top of foot. While the injection didn't seem to offer immediate relief, when I went back a month later for my follow exam up,I was pain free for a week. My doc said that the while I may get intermittent episodes, they would be further and further apart. I went for a period of 4 weeks pain free, then one episode. Another 4 weeks pain free,
then one episode. However, beginning last week I seem to be having them daily again. I have to admit that when this began I was wearing high heeled flip flop type shoes, which I now know was a mistake. Since August however, I have only worn a pair of wide toed, flat shoes and have been wearing gel pads for the ball of my feet. I ice after walking and take ibuprofen. (My doc said I could continue to walk)
The pain episodes last only a few seconds, some are mild, some aren't, and are very intermittent. One a day, two or three at the most.
My questions are:

Since the pain is on the inside of my big toe, at the joint by the nail, could this truly be a nueroma? I have no other neuroma symptoms and I understand that this is not a usual place for one form.
If my foot doc is correct about the diagnosis and prognosis, how long can I expect this to last?
What else can I or should be doing?
Should I see an Orthopaedic Doc?

Thank you.

-----Answer-----
Hi Helen,

I have a few questions for you and some answers as well.

How old are you? You can give a ball park age.  What other activities do you do?  Do you have any medical problems?  Anyone in your family have severe arthritis, autoimmune problems or gout.

This does not sound like a neuroma.  You are correct this would be an unusual place for a foot neuroma.
I still would suspect an abnormally functioning joint possibly with arthritis. You may possibly have an extra bone at the bottom of the joint called an accessory sesamoid.

There are other imaging techniques such as MRI that may give more information about the joint and surrounding tissue.

I would seek a second opinion from another Podiatrist.  Orthopedic surgeons are generally have limited knowledge of the foot.  Podiatrists are the only true foot specialists.

If you would like you can send me more info.

Sincerely,

Marc Katz, DPM
Advanced Podiatry
Tampa, FL
http://www.theTampaPodiatrist.com
http://www.TampaCryosurgery.com

Answer
Helen,

I believe you need to explore the possibility of a condition known as gout.  Many of your foot symptoms are consistent with this condition.  You can have your blood drawn and check your uric acid levels.  If they are high, you have gout.  Gout attacks can cause arthritis in the joints as well.

Have that checked first by your Podiatrist or Primary care physician and then we can go from there.

Let me know how it goes.

Sincerely,

Marc Katz, DPM
Advanced Podiatry
Tampa, FL
http://www.theTampaPodiatrist.com
http://www.TampaCryosurgery.com