Burning, prickling pain on the bottom of both feet.

by Rocky
(Wichita, KS, USA)

Hi! I have been to a podiatrist twice where I received custom orthotics with many adjustments, an x-ray with no bone spurs present, a night splint, ibuprofen, and cortizon shots. I have been to physical therapy for strengthening and A-stem treatment. I have been to a rheumtologist for a physical evaluation and had bloodwork done for an autoimmune disease only to have negative findings. I have been to a neurologist for an EMG. Tarsal tunnel syndrome was diagnosed. I had surgery to include a plantar release and a tarsal release. I am currently taking Nuerontin prescribed by my family doctor which was suggested by the neurologist upon completion of the EMG. I continue to have pain. It is extraordinary pain especially when standing or walking. It feels as if I am standing on a bed of needles that jab into the bottom of my feet as I stand or walk. I also have deep pain in the mid arch portion of my feet. I do not like the pressure of pool water or spa bubbling water on my feet as it causes me pain and irritation. I walk as if I am crippled limping with shooting pain. Stretching continues to be a daily regiment as well as icing with seems to cause my foot to stiffen up leaving me with increased pain when I step down to walk. I am driven to tears, nausea, and even thoughts of dying from the pain. No one seems to be able to end my pain problems, or even lessen them for past two years. Since my first doctor's visit for foot pain, it has gotten progressively worse. I have no idea what the origin of the pain is at all. Do you have any ideas as to what is going on with my feet because no one else does at this point?

Thank you,
Rocky

Hi Rocky,
Thats a tough one. Has your neurologist examined your back to make sure that you do not have a radiculopathy which is a nerve impringement coming out of the spinal column?
Sometimes, although not in high incidence, some people can have a nerve entrapment at the head of the fibular (the outside bone in your lower leg, just below the level of the knee). This too could also cause your symptoms.
Your pain certainly sounds like neurological in origins, but your doctors may have to start looking at places other than the feet as the source of the pain.
Marc Mitnick DPM

Sharp pain in the bottom of my foot when I lift my toes back, specifically the ball and along the length of the outer edge under my pinky toe.

The problem started 5 days ago when I was at my job, I am a bartender and was loading beer into the drop cooler. You have to bend over to get into it, when I resumed a standing position that is when the pain started in my foot. Immediately it hurt to put pressure on it and I assumed it was a charlie horse or a knot of some kind so I flexed my foot and lifted my toes back to no relief. Subsequently I had to work for another 6 hours limping, you can imagine how that went. That night I soaked my foot and attempted to rub out what I thought was a muscle spasm, put some bengay on it and called it a night. The next morning I woke to more swelling then there was the night before and strange purple bruising on the arch of my foot. The next couple of days didn't get any better as far as the pain is concerned, there is no longer any swelling though. Some soreness and throbbing pain in my calf and foot have accumulated probably from walking funny for the last five days. This morning I woke up to slight bruising on the top of my foot under the length of my toes and the pain has now become specific to the aforementioned areas above. When I pull my toes back there is sharp pain in the ball and side of my foot and not so much the arch any more. Is this something I can fix at home? Or is it recommended that I see a doctor, bear in mind that I lack health insurance so I am a little weary about spending money on an appointment only to find out I have a knot. Also I obviously work on my feet for long hours due to my occupational stipulations so I need to figure out what the issue is as soon as possible. Thank you very much for taking the time to read this over.

Hi,
Read my section on
capsulitis , as I think that is the most probable cause of your pain based on the way you were bending your foot at the time of the accident. However, there is the possibility of a stress fracture which in many ways could produce the same amount of pain.
A podiatrist would be the best type of doctor to see as this is a condition that most nonfootspecialists would never diagnose.
Marc Mitnick DPM

I get a needle type pain every so often in the bottom of my right foot

It happens all of a sudden. Then it may not again for hours. Then it may happen every 5 minutes. It started today.

Hi,
Assuming you do not have a foreign body in your foot or some kind of skin growth like a wart, you probably have a neuritis or an inflammation of a nerve ending.
If it continues, you may want to have a doctor confirm that or perhaps see if it is from some other source.
Marc Mitnick DPM

Sesamoid Tendon

by Kim
(USA)

I was in a car accident. I had to hit the brake pedal very fast and hard (I was barefoot) Immediately following the collision I could not move my right foot. My big toe hit the brake pedal first and it had rubber from the pedal embedded in the skin on the bottom. I went to our family doctor the next morning for an xray, he said nothing looked to be broken and I should do rice until it feels better. I could not bear weight on my foot. My entire foot swelled up whenever I did not have it elevated. Two weeks later I finally went to a Foot Surgeon and after more xrays and a MRI's I was diagnosed with a rare condition that my Dr. had only seen once in 24 years of practice. "Intersesmoidal Tendon Rupture" He said the only treatment option was surgery to graft the tendon back together. Since this is a rare disorder I have no idea what to expect after having the surgery. Have you ever encountered this before?

Hi Kim,
I would assume the doctor actually meant intersesamoidal ligament rupture as there is no tendon that connects both sesamoid bones. I will assume this was a finding from the MRI.
Before consenting to surgery, why not consider a nonweightbearing cast in an effort to see if the ligament will heal itself. The ligament in question is a very short ligament as the space between the sesamoid bones is very short and a period of immobilization may do the trick. If not, you can always have the surgery. The expectation whenever surgery is mentioned is that the surgery will solve the problem. What if it doesn't. You may be left with more pain than you started out with. Always try the conservative treatment first.
Marc Mitnick DPM

A black and blue bruise over the entire underneath and side of the ball of my foot

I am a 50 year old female with history of hypertension, stroke, degenerative disc disease, and hypoglycemia. I have decided to train for a half/full marathon walk/run. I am participating with a group and I have a training schedule from a sports coach and trainer that I meet with once a week. I am up to 5.4 miles per day. I run 5 times a week with two days off. I am running well and do not have pain in my feet however, this morning when I woke up I noticed that the entire ball of my left foot was marked with black and blue bruising. There is no pain although it does feel a little funny and numb. When I run or walk I have a tendancy to step on then outside of my feet and not usually on the ball. I don't want to make a big deal out of this. I don't want to stop training. I just wondered if this could be anything serious as I do have some blood sugar problems. It is just really weird!

Hi,
With you medical history anything that looks "weird" should be examined by your doctor just to make sure it is nothing serious.
Let he or she tell you its nothing, this way you can continue your training with peace of mind. I hope you achieve your goal of running in a marathon.
Marc Mitnick DPM

ball of foot throbs and big toe joint is unbearable to bend

by janet
(IL)

I was painting and going up and down a ladder and did not have good shoes on and sometimes did not have shoes on. A couple days later the bottom of my foot started hurting and I ignored it and just kept doing things through the pain and one morning I woke up and my foot was swollen on top and I couldn't walk normally to bend my foot forwards. I started to soak it and started taking wobenzyme for the imflammation and also ultram for the severe pain. I borrowed a post surgical shoe from a friend and I limp all around in pain. I was now given an air boot from the friend which is so heavy and high and I haven't attemtpted going out with it yet.

The foot throbs constantly on the bottom, is this sesamoiditis? and will the boot help? Also how long does it take to heal since I am taking care of an elderly mother on a daily basis. Also like everyone else I don't have insurance since my company closed over a couple yrs a go and I can't afford to get personal insurance. Is this something that can be taken care of at home without seeing a doctor (foot specialist).

The throbbing is the worse, I tried iceing it instead of the soaking with epsom salt and feels better while I'm doing it but the throbbing never really goes away and it keeps me up all night long even taking the ultram and wobenzyme. I can't take motrin etc. because I have kidney problems

Hi Janet,
Apparently you overstretched something by climbing the ladder with poor shoes or no shoes. I cannot make a diagnosis because I do not have the luxury of examining you.
However, you certainly can try all the things that go along with a strain. That would include anti-inflammatory medication (if you can tolerate it), warm soaks, 20 minutes three times per day, and immobilization, probably the surgical shoe being the easiest thing to wear. Additionally, if somehow you could stay off your foot for a few days that would also be helpful.
If these suggestions do not improve the pain, then your best option would be to seek medical attention.
Marc Mitnick DPM

ball of foot pain two years after bunion surgery

by nikki

Two years ago I had bunion surgery on both feet. They cut, moved and pinned bone in the big toe on both feet. They also removed the middle knuckle of the toe next to the big toe on both feet and cut the ligament of those two toes as well (so that they would "fall" back down - they were "raised" from my big toe being under it, if that makes sense). Aside from some slight pain and discomfort I healed ok; However, now I am having terrible pain in the ball of my right foot between the big toe and the toe next to it. No matter what kind of shoe I wear it hurts; hurts to walk or run on it, hurts to stand on it, just hurts. Has anyone else had this same surgery and had/having any similar problems? Thanks

Hi Nikki,
Interesting description of the surgery, actually I have a decent picture of what you had done.
Nonetheless, in general terms, if the pain you have now has not not been with you since the original surgery there is the possibility that it is an unrelated problem.
Having said that, one problem that may have arisen as a result of the surgery itself is a sesamoiditis (read my section on sesamoiditis) as sometimes the sesamoid bone is irritated during bunion surgery.
The only way you are going to know for sure is to visit your surgeon and let he or she examine you.
Marc Mitnick DPM

Pop in the bottom of foot, followed by pain that is increasing over time

by Michelle
(North Little Rock, AR)

While playing tennis today, I felt/heard pop in the bottome of my foot. The pain went through my arch and was unlike anything I've ever felt. I mean I've felt worse pain, but it made me nauseated - weird. I was able to walk to the car, but as the evening progresses the pain is increasing. It hurts in the arch and heel. I am able to point and flex my toes with out sharp pain, but can bear NO weight. I plan on contacting my IM doctor in am, but it usually takes a couple days to get un and staying off of it as much as I can. I am getting very concerned though, would feel better if I had some idea what it was. Help!

Hi Michelle,
It sounds like you might have torn a ligament or perhaps a tendon but I am only guessing. I would bypass your internal medicine doctor and this is not their area of expertise. Instead I would go to a podiatrist or perhaps an orthopedist as these types of doctors are more adept at treating this type of problem.
Marc Mitnick DPM

stabbing pain in ball of foot under baby toe

by Tom
(Victoria, Canada)

Mornings are the worst time for severe pain but the pain is there always. It never goes away. It feels as though I'm walking on broken glass. There is a small red spot which appears to have something in there. This red spot never goes away. If I press on the spot there is immediate sharp pain. Bearing weight is the worst of it and when I sitting or resting the pain is there, it's just not as severe.

I used to have only one spot directly under my baby toe but now there is another under my big toe. Both spots are equally painful. The spot under my baby toe I've had for about 12 years the newest spot under my big toe just appeared this year.

I have been told it was a plantars wart and it was burned until it got infected and then they decided that it wasn't a wart!!!

I have had many X-rays with no results.

Sometimes it feels like the bottom of my foot is on fire!

The spots get calloused as though there is something hard in there and it's working it's way out however there isn't anything hard there.

When it was being burned (because they thought it was a wart) I was able to shave down the calloused area and a small hard lump, sort of like a hard piece of skin, came out and left a small hole. The pain went away at that time but it only took about a week for it to come back.

I continue to shave down the callous but haven't gotten anything out of the spot since. When I do shave the callous it appears to be a horseshoe shaped sore.

Hi Tom,
In that situation I would put the area to sleep and excise the whole thing and biopsy it. Sometimes warts are not warts and it may be something else. Have it taken care of.
Marc Mitnick DPM

Pain in ball of foot

by Jackie
(Virginia)

Over two months ago I was trying to catch a gecko that was in my dorm room and somewhere between running around, stepping on and off chairs, etc, I injured my left foot. I've never broken my foot before so I don't know what that feels like, but it literally felt as if a bone in my foot, the ball of my foot between my 3rd and 4th toes (my big toe being the first), was dislocated. I figured I had bruised it stepping off the chair and iced it and went to bed hoping it would stop hurting by the end of the week.

It did stop hurting, but since that time it would act up and be a dull pain in the same area. Very recently my foot pain has increased tremendously (to the same level it was when it had first happened) when walking and doing regular activities. I can still walk on the foot, but not on the affected area. It feels like a cramp, but one that has been caused by something being out of place, in the ball of my foot that reaches to the 4th toe and during these times it hurts regardless of whether or not I'm walking on it. There is a small abnormality on the bottom of my foot being a slight bulge (but that's as related to my other foot so I don't know if it's always been that way. After these periods my foot will hurt like it was bruised on the bone in the same spot. When these new pains started I noticed that a bruise was visible on the skin between the spot where the 3rd and 4th toe connect to the foot. These periods of intense pain have occurred 3 times a few days apart and my foot remains slightly painful (like a bone bruise) in between. I have inserts in my shoes which tends to help. Flips-flops don't work and tend to hurt my foot so I stick with shoes.

I have yet to see a doctor because I'm worried about the cost of an X-ray that would probably show a minor issue. If it's a problem that I can fix by simply wrapping my foot, getting crutches for a few weeks, and waiting for it to heal I would rather do that than pay thousands for someone to tell me the same thing.

Thanks a lot for any help.

Hi Jackie,
An xray will not cost you thousands, in fact when you call to make an appointment, ask beforehand what they charge for an xray. Most colleges have student medical services and you can probably get an xray there.
Anyway your problem is that you have waited two months. If indeed you do have a fracture (and you may not) the longer you wait before implementing treatment, the greater the chance that you will have problems. In other words, a fresh fracture needs to be treated right away and in your case it has been two months.
Since it has been two months since your injury and since you are still having pain, I think you should have your foot examined to get an accurate diagnosis and then appropriate treatment.
Marc Mitnick DPM

Holiday surprise- glass in foot

by Saskia
(California)

After a lovely holiday in the sun, flip flops etc. i got back home with something that looked like a spot in between my big toe and the second one, off to the GP,.. diagnosed bunion in between my toes due to pressure from my flip flops,.. salicylic- acid cream to burn it off the skin,..a week later the delicate skin in between my toes completely ruined and the spot still there, off to
hospital dermatologist, ...diagnosed with a insect sting in between my toes he added he was sure it wasn't cancer,... he told me to come back in three months time,.. have to walk to work couldn't walk well got totally fed up after nearly two months of limping,.. soaked my foot in warm water to "mature" my spot, called my mother to come and help me,.. she just "squeezed out" a massif piece of glass,... and she never went further then high-school and accepted cake for a fee,......

Hi Saskia,
Thanks for the great story. It never ceases to amaze me on the crazy things that can happen to people.
Marc Mitnick DPM

Pain in the bottom of my foot between my heel and arch

by Sophie
(Orlando, Fl)

the pain is very sharp and has been going on for two weeks. I massage nightly with aspercreme but no help no relief at times pain can be more intense than others. Started after walking one evening. sometimes the area swells as well.

Hi Sophie,
You may have nothing more than plantarfasciitis (read my section on heel pain) or you could have something as severe as a partial rupture of the plantarfascial ligament.
Since the pain has been present for two weeks and does not seem to be resolving your best bet would be to make an appointment with a podiatrist and get proper medical attention.
Marc Mitnick DPM

psoriasis on feet?

by M. Harris
(Beloit, WI, USA)

I have a itchy area on the balls of my feet, I thought it was not psoriasis because I have had that before. I have had it about 3 months. To me it looks like really dry, crakey skin. It hasn't bubbled or peeled but I have tried anti-fungals and lotions, nothing seems to work. Also I find it really pecullar its location on my feet(both). Any info will help me decide weither to go to a skin doc or a foot doc.

Hi,
Since I cannot look at it, I do not know what it is, but I will suggest a couple of things. If it is athletes foot, the biggest mistake people make is that they do not use the antifungal medication long enough; you may have to use it for upwards of four weeks, twice a day. Secondly,you have to try to eliminate the dark moist environment that fungus thrives in. Read my section on "athletes foot" for tips on how to do this.
Lastly, because you state the irritation is on the bottom of both feet, you also have to consider an allergic reaction to either a material in your shoes, or something you may be walking on when barefoot.
In any case either a podiatrist or dermatologist should be able to help you.
Marc Mitnick DPM


Thanks for your time,
M. Harris

bottom of foot hurts

by Tammy
(IL)

I have a cut on the heal of my foot. I am not sure how I got the cut, it has been two weeks and will not close up. As time goes on it hurts more and more to the point where it hurts to walk on that foot. I keep it as clean as I can. The cut does not seen deep but was thinking maybe I still need stiches. Any advice.

Hi Tammy,
May sound like the obvious, but go see a doctor. The skin on the heel is very thick and sometimes hard which can cause it not to close. Plus walking on it also can slow down the healing process.
So, if it has been two weeks, it is time to get some professional care. The longer it remains open the more likely it is to get infected.
Marc Mitnick DPM

Stabbing pain in heel and arch that radiates into the leg

Years ago, I tore most of the ligaments in my right ankle in an accident. Over the past few weeks, my foot has been swelling throughout the day, but there was no pain associated with the swelling. Last night, I began having sharp, stabbing pain in my heel which radiated up my leg. This occured repeatedly for several minutes and then subsided for a few hours only to repeat the cycle several times during the night. The pain was severe enough to wake me from a sound sleep each time.

Hi,
I am not sure the old ankle injury is related to the present problem.
The most common cause of the type of symptoms you described is generally from a heel neuroma (read my section on that subject).
Having said that, if the pain is severe enough then it will require medical care and a confirmed diagnosis.
I would suggest you see a podiatrist in your area for further evaluation.
Marc Mitnick DPM

Pain in arch of right foot.

I always tend to go barefoot the moment I get home. Recently, I started experiencing pain in the arch of my right foot. It happens particularly if I go barefoot on my hardwood floors. Are the floors what is causing this pain?

Hi,
Read my section on heel pain, particularly plantarfasciitis, that would be the most common, but not only, cause of pain from walking barefoot.
You might find that to alleviate the problem you keep your shoes on at home, something most of us prefer not to do.
Marc Mitnick DPM

severe itchiness on the sole and side of the foot

by Lelu
(California)

Sole (where the arch is though I have flat feet) and side of foot (outside edge right above ground level) is affected. Certain areas become intensely itchy and when rubbing the skin in efforts to relieve itching, the skin becomes loose over the affected area. I will cut out the skin (same area of skin that became loose) which alleviates the itchiness but results in pain. I cut into the skin pretty deep then cover with a band-aid and sometimes Neosporin. I have also noticed two microscopic dots on the inside of my foot in each area that I cut away. I don't know if this helps with the diagnosis...

I have tried all sorts of anti-fungal topical creams but the itchiness doesn't seem to start on the outside of my foot and the creams do not work. I feel like I have to "dig" it out, literally. I am left with gaping wounds on my feet that are very sore and then they scar over.

I have been researching various forms of Tinea Pedis online and there was an article about a a form of Tinea Pedis that refers to a moccasin because of where it affects the foot (bottom and side) which sounded like it could be similar to what I am experiencing. I do know that it is not Athlete's Foot.

I have had this condition for some time now but the itchy areas didn't bother me as frequently nor as intensely as in the last 6 months. I have been experiencing more frequent itching spells and because I cut out the skin on the itchy areas I am all cut up and in pain.

I think I remember my biological father having some sort of foot condition but I think I also remember him not knowing exactly what it is.

I wear shoes and flip-flops but wearing flip-flops feels much better when I am experiencing an incident. Shoes rub and make my feet warm an sweaty. Flip-flops allow the skin to dry and heal.

Thank you for any opinion you can offer. The first time I saw a podiatrist they told me to use the topical anti-fungal creams but again, they did nothing to help.

Hi Lelu,
Obviously, it is impossible for me to know what kind of skin condition you have without actually examining you, so I would read my section on athletes foot and along with using topical fungus medication, you should also follow the other guidelines I recommend.
Try that for 3-4 weeks, if that does not work, then you need to see a podiatrist or dermatologist to make an accurate diagnosis.
Marc Mitnick DPM

Glass like feeling in the ball of my left foot

by ann
(Calumet, Mi)

I am having a glass like feeling in the ball of my left foot. It is a nonstop pain and worse when I walk on it. I have had this problem off and on for the last 4 years. (I have had it in the right foot once) When it starts it lasts from 2 days to 2 weeks and then just goes away. and may come back in a few weeks or a year.
I have had x-rays and they show nothing. It is very pain full and makes it hard to walk. I want an idea of what the problem my be and what to do for it.
Thank You.
ann

Hi Ann,
I doubt you have a foreign body in your foot because what are the chances of having one in each foot. Having said that, an x-ray will not always show a foreign object, you will need to have an ultrasound.
Assuming no foreign body it sounds like you are having a nerve entrapment type pain.
See a podiatrist, in these cases I would either try some anti-inflammatory medication or perhaps a cortisone injection.
Marc Mitnick DPM

right foot - ball of foot pain-going on 2 years

I am seeing a podiatrist, but do not feel I am getting enough attention, or answers. Two years ago I had no specific injury, but I had been wearing sandals and my ball of right foot started hurting. I saw my podiatrist and he mentioned capsulitis and metatarsalgia, my x-rays showed no injuries. I have extremely high arches and used to teach dance lessons, putting a lot of strain on my feet. After some cheap inserts, and no real progress, my podiatrist gave me a Powerstep orthotic. I have worn it for a year. I wear only New Balance shoes. I am rarely barefoot, as it is worse then (maybe 30 minutes/ day). I am a stay at home mom, so am on my feet quite a bit. I have stopped exercising- giving my foot a chance to heal. After a year the extreme sensitivity of it was gone, I could touch it w/out it hurting and point or curl my toes w/out it hurting. However, it was not healed. If I went for a 2 block walk, it would throb later, and still always hurt, just not as bad. Two months ago I was fitted with prescription orthotics, but they do not have a metatarsal pad. I wore them with my Powerstep orthotics for 1 month (just for the padding), but the nurse advised me not to. I just got some cheap flat padding at the store and wore them for 1 week that way and seem to have undone much of the healing that has occurred. I have a follow-up appt. with the podiatrist next week, but am not sure what questions to ask him, or what type of product I can use with my expensive prescription orthotics. I definitely need more padding. Will this ever get better? I would love to just take a walk with my children. What else can I do to help this heal?

Hi,
The problem with high arched feet is that most over the counter arch supports are not supportive enough.
Secondly people with high arched feet are prone to metatarsalgia and capsulitis.
Based on your description I would certainly think you would need a metatarsal pad or perhaps even a metatarsal bar in your prescription orthotics in an effort to take pressure off the heads of the metatarsals.
Talk to your podiatrist, if you get no satisfaction, seek another opinion. Keep in mind, metatarsal pads can be added to your existing orthotics, so do not be conned into buying a new pair of orthotics.
Marc Mitnick DPM

Pain in balls of feet

I have lost 90% of the padding in the balls of my feet due to
running and wear and tear of 64 years. Is there a procedure to
add paddding to the feet?

Hi,
Over the years there have a few different substances that have come on the market that were designed to replace the plantar fat that most of lose as we age. Most of these products have been a huge disappointment mainly for the simple reason that the substances do not stay put. Once you start walking the substance that has been injected begins to disperse away from the painful area. (if you squeeze one end of a water balloon, the water moves to the other end). This is the same problem that occurs on the bottom of the foot.
The best and for now at least, the only way to treat lack of a plantar fat pad is through the use of an orthotic that has a cushioned layer on top of it. There are many different materials out there that will cushion the ball of the foot. You may to experiment around until you find the material that is right for you.
You may want to consider consulting a podiatrist who should be able to help you with your selection.
Marc Mitnick DPM

pain in ball of foot

Developed seisamoiditis in right foot five years ago from treadmill. After staying off my foot extended periods of time, I never completely got rid of the pain. Used crutches, wheelchair, and special boots to no avail. I continued to take long walks and dance on my foot when it was hurting. Had the medial sesamoid bone in my right foot removed Dec of 2008. It's been almost a year now but I still have pain in the ball of my foot as I did before the surgery. The removed sesamoid was not fractured or broken and I definitely will not have the lateral sesamoid removed. Could I have peramenent nerve damage from excessive trauma to the foot. Should I have a nerve conduction test done on that foot to determine if it's the nerves in that area of the foot? If nerves are damaged from trauma, how long would it take for them to heal so I could walk again without discomfort and pain. The more I walk, the more discomfort and pain I feel. I'm a very physically active person and this situation has been devestating.

Hi,
I know this is 20-20 hindsight but I would not have been quick to have the sesamoid bone removed and I certainly would not have the other one removed as it will destabilize the big toe joint. As well as the fact that in 30 years of practice I have never seen a patient who had pain in both sesamoids on the same foot. You need to have your doctor look somewhere else for the source of the pain. Read my section on
sesamoiditis and you will see it can be a very difficult problem to treat.
Without being able to actually examine you, I do not know if it is a nerve problem and I am not so sure a nerve conduction study will tell you anything anyway.
I would first go for an MRI of the area and I certainly hope you have been wearing some kind of orthotic in your shoes as that is the most effective way to deal with sesamoid problems.
Marc Mitnick DPM

Sesamoid pain???

by Monty
(Santa Cruz CA)

I am having some left foot pain - on the inside of the big toe and the 1st m-head, plus just below and between the big toe and the ball of the foot. I have a slightly dropped 1st ray - very high (but flexible) arches, and I pronate alot. I am trying to work around my problems and wonder which arch support you recommend. I am only 130 lbs and do a lot of competitive cycling so thoose shoes are ultra rigid but still do have room for a good support if it isn't too thick...

Hi Monty,
I am not clear if your pain is all the time or only when cycling. Anyway, for sesamoid pain, if you are going to buy something in the drugstore, then look for the most cushioned type of arch support you can find. Try them and if they work, fine, but if not, make an appointment with a podiatrist, let he or she make an accurate diagnosis and if necessary fit you with a prescription orthotic.
Marc Mitnick DPM

Pain on the bottom of my left foot

by Steve
(Placentia, California)

First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.
I am a very active 49yr old man in good health, and on the bottom of my left foot in the foot pad area at the 5th metatarsal region I have pain whenever I stand or walk on it and there is no pain while sitting or sleeping. The pain is worse when walking barefoot than in shoes. It feels like that part of the foot pad is swollen, and it causes me to walk differently, but I don't really see a difference when comparing it to my right foot. From day to day the pain on average is about a 3 on a scale of 1 to 10. But after a long day of working on my feet the pain goes up some. The pain seems to be aimed more towards the edge of the foot pad towards the heel rather than towards the toe, and also the pain sometimes radiates up through my pinky toe. I don't have any pain on top of my foot and I can move my toes freely without any pain.
This all started about 9 months ago with a nagging little pain and so I stopped playing tennis, and other recreational sports thinking I would give it time to heal. But it is still with me today and seems to be slowly getting worse. Two months ago I went to my doctor who took X-Rays, gave me Ibuprofen and said to rest. And then more recently I went to a Podiatrist, within the healthcare network, who gave me about 5 minutes of his time to look at X-Rays and said I have a Tailors Bunion and recommended orthotics or surgery as the answer. After reading your section on Bunions I am not convinced of his prognosis. I am one week into wearing custom orthotics which helps some because they made an impression in the orthotic in that part of my foot pad. But it still aches by the end of the day.
I'm thinking of getting a 2nd opinion and requesting an MRI, but with what kind of doctor. Should I go back to a different Podiatrist or should I go to an Orthopedic Surgeon specializing in lower extremities? And what will an MRI reveal and which doctor should be performing it? Any help would be greatly appreciated.

Thanks,
Steve

Hi Steve,
The two most common (but not only) conditions that cause pain in that area of the foot is a submetatarsal bursitis and a porokeratosis . I would think any podiatrist worth his salt would have noticed a porokeratosis so I assume it is a bursal sac.
Before I would consent to surgery (and I am not sure Tailors bunion surgery is the answer) I would recommend having a cortisone injection along with wearing the orthotics that attempt to take pressure off the head of the metatarsal with the underlying bursitis.
If the diagnosis of bursitis is made by your podiatrist (see another one) then you may also want to consider Physical therapy as a means to calm down the inflammation.
I would only order an MRI if I suspected a more obscure cause of your pain and I am also assuming the xray that you had showed no sign of stress fracture. Good luck.
Marc Mitnick DPM

Itch on bottom of left foot

by Marsha
(Michigan)

I have had an intermittent itch on the bottom of my left food on and off for five years. It comes on suddenly, lasts anywhere from 1-6 months and is located towards the middle left side of the bottom of my foot where my skin is very soft. A while ago I was told by a neurologist that is was an irritated nerve and there was basically nothing I could do. It is worse at night and when I am standing or walking, doing other physical activity is doesn't bother me much. I do not scratch it because that seems useless. I've tried lidoderm patches but that doesn't seem to work. I have a bit of a toe fungus and occasionally have a fungus between my toes but I'm not sure that is related to this at all. Anything I can do about this?

Hi Marsha,
If there are no actualy skin lesions in the area that itches then I am in agreement with the neurologist that it is probably a nerve irritation.
Some of your options include a cortisone injection into the area, or perhaps a round of anti-inflammatory medication in an effort to reduce the inflammation around the nerve.
You could also consider medications such as Lyrica, Neurontin, or Pamelor which are neurological medications used for abnormal neuropathic sensation in the extremities but truthfully I think those may be a case of "overkill" for the type of problem you have and because they do have side effects.
Lastly you might even consider ultrasound physical therapy in an effort to "quiet" the nerve.
Marc Mitnick DPM

Pain ball of my foot.

for the last 8 weeks or so I have had such pain as what can olny be discribed as walking on broken glass, I felt two small spots tiny on the ball of my foot, I first thought I had glass stuck in my foot. but nothing was there but the two spots, that are very painful to touch. I have a very high pain tolerance but it is now getting unbearable.. please can you help thanks Karen:)

Hi Karen,
It sounds like you may have a soft tissue growth on the ball of the foot, which could be anything from warts, to a porokeratosis, to an intractable plantar keratoma. (See my sight for details on each).
You could see a podiatrist who could probably give you some relief. You could also buy a cushioned innersole in a drugstore that might also help, but if the pain persists, you are going to need professional care.
Marc Mitnick DPM