Ball of foot pain - Blue Purple colour comes and goes

by Des
(Alberta, Canada)

A few years ago I noticed a tender spot in my right foot, about center of the ball of the foot or between the 2nd and 4th digit about one inch in from the base of the toes on the under side of the foot. I have always been a very active on the go kind of person. I am about 105 lbs not over weight by any means. Mid 50's in age and female, if that matters.

I was told my fat pads were thinning and to add more cushion in the shoe. I followed medical advise but it did little to help.

Early in 2012 during massaging the area a small pea size node was felt. While adding slight pressure to feel it, it disappeared. Shortly after this I felt extreme pain in the ball of my foot and have been in extreme pain since.
I now have trouble sitting or standing in one spot for any length of time (more than 5 minutes) without my foot turning numb, painful and a blueish purple and cold to the touch. Much like tying an elastic band around the foot and forgetting to take it off for a while...that kind of feeling. When I move around the normal colour returns, the pressure is released and I am just feeling the pain. I have pain with every step that I take and find any shoe and sock binding and uncomfortable. My 2nd digit on the right foot is slightly more bent than the 2nd digit on the left foot. It feels as though I have a mass right under the toe area where the padding begins and then behind that is the pain. The area seems slightly swollen. Warm foot baths seem to aggravate it further as does the warm shower, it becomes the cold blue purple colour and seems more swollen. Advil and Tylenol do little to relieve.

I have seen several podiatrists and specialists, each telling me it is something different.
First podiatrist advised it was bursitis and treated it with a metatarsal pad and Diclofenac cream. An ultrasound was requested. The metatarsal pad only added to the irritation and the ultrasound showed nothing.
Second podiatrist and specialist advised he could visually find nothing wrong. He advised me to try a MBT rocker shoe with a "Sole" insole and to be in these shoes from the time I got out of bed to the time I went to bed. I followed through and was able to move around somewhat better initially but a week into wearing this shoe I could no longer stand the pain on my sesamoid area. Now a second area of both feet were inflamed. Returning for his advise he suggested I cut down the amount of hours that I wear the shoe. I tried this for a short period and found no change and had to stop wearing the shoe all together.
Third podiatrist suggested it was metatarsalgia and prescribed a topical spray and ortho inserts and Naproxen 500. I followed through and am totally unable to even stand on the orthodic. A total waste of $600.00. The Naproxin takes the edge off on really bad days.
Fourth podiatrist suggested it was a neuroma and again prescribes ortho inserts, which I follow through with. I purchase a really good pair of Nike shoes for these inserts but am unable to stay in them due to swelling and that binding irritation.
Fifth podiatrist suggests it is a cordial problem, suggests another shoe and ortho inserts. I did NOT do this round.
My ultrasound shows nothing
My Xray shows nothing
My bone scan shows inflammation from the waist area down
My blood tests for electrolytes, vitamin levels all come back good
I am told it is not gout
Almost a year later I finally get my appointment for an MRI (yes, it takes a year for feet, sad but true)it shows no significant joint effusions, no bursitis, tiny ganglion cysts involving the lateral cuneiform at 3rd TMT articulation measuring 7mm, a small 5mm cystic leison along the plantar aspect of the 5th metatarsal, possible ganglion cyst or bursa, muscles are normal, flexor tendon intact plantar fascia intact. no intermetatarsal mass to suggest a neuroma.
Lower spine shows a slight bulge at L5, S1 which I am told is quite normal,
I next am told to go for a Doppler ultrasound which comes back good.
I have recently tried physio and 3 rounds of acupuncture which has done nothing but flare things up worse.
I also tried a few visits to the chiropractor that went no where.
I was reading your topic on capsulitis........and wondering if you think it could be this problem?
Any serious direction would be greatly appreciated. As you can see I have put much effort into finding a solution,and I am still searching.

RESPONSE

Hi Des,

I have read your narrative and have a few comments.
If you actually felt a lump and pushed it back into your foot (which then caused pain) you have a growth in between your metatarsals, regardless of what the MRI says and I can tell you over the years I have surgically removed masses in that area of the foot where the MRI was negative for soft tissue growth.

I am only guessing here, but more than likely it is either a ganglion cyst or bursitis with a lesser chance of neuroma.

I do not know what the quality of medical care is in Alberta, Canada, but based on your story I am a bit underwhelmed. Shoes and orthotics only solve problems up to a point and then more aggressive treatment has to be considered. Has anyone given you a cortisone shot in the area where you felt the "lump"? That would be my first choice of treatment.

What actually concerns me more is your narrative about the pain, discoloration that you are getting in the foot. I do not think it is related to your growth in the forefoot.

In general when people have discoloration in their feet it is due to a circulation problem of some sort. The fact that the foot feels and looks better when you walk on it is highly suggestive of an arterial problem, meaning there is difficulty in blood coming into the foot, thus causing the discoloration and pain. Once you walk on the foot, gravity helps the blood flow and the foot feels better. If this discoloration only occurs in cold weather then you may have a vasospastic disorder where the cold temperatures clamp down the blood vessels usually in the feet and sometimes the hands. If this is occurring all year long then it is possibly a more severe problem.

My suggestion is to see a vascular specialist immediately as this circulation problem is potentially more dangerous than the lump in your foot. Once the discoloration is accounted for (and I hope you are not a smoker, as that exacerbates the problem), then you should deal with the lump in the ball of the foot. I would start with a cortisone injection or two; if that does not help, then you may want to consider surgical intervention to explore the area.

BTW, your problem does not sound like capsulitis.

Marc Mitnick DPM
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