Pain on the ball of my foot, feels like I'm walking on a marble...

by Greg
(Dallas, TX)

So the pain just randomly starting hurting one day and I didn't think to much about it. Well, after months went by and the pain didn't go away I went to a foot doc. He described the issue as my toes have begun to curl and my middle bone is beginning to push itself out. Basically, I'm walking on the bone. He recommended getting custom inserts and was going to contact my insurance. Months have gone by and I've heard nothing from him and his assistants don't know anything about anything. So my question is do I need custom inserts for the rest of my life or can I correct the issue with surgery or some other process. I'm a very active male and I can't run, bike, or exercise at this point and it't driving me nuts. Also, I'm 26 and I don't want to deal with this for the rest of my life, if surgery or something else could correct the problem. Side note, but may be of some interest... in this same time period I went through a growth spurt. I've been about 6'4" my entire life but within the last few months I have grown another 2 inches or so. My shoes have gotten tighter and I was wondering if the growth spurt made my foot grow into a disformatity... Please tell me what you think is the best option. Thanks

RESPONSE

Hi greg,

Based on your narrative it sounds like you have what is known as a plantarflexed third metatarsal meaning the head of the third metatarsal is bearing more weight than the other metatarsals and thus you are having pain.
The curling of your toes puts a retrograde pressure on your metatarsal bones and in your case it is the third metatarsal that is affected.
I will have to assume the podiatrist knew what he was talking about even though because of your age, I am not so sure.
In any event, there are a couple of issues that need to be addressed. Any honest doctor, one who cares about his patient would certainly offer a conservative treatment option before offering a surgical solution to your particular problem.
The most common conservative treatment for a plantarflexed metatarsal is for an orthotic. Usually an orthotic with a built in metatarsal pad whose purpose is to take weightbearing pressure off the metatarsal head. This can be a very effective means to an end.
The question now becomes who is going to pay for them. Well, you have two choices. One is to just pay for them out of your pocket or you can be proactive and call your insurance company yourself. Just ask them if your plan covers prescription orthotics. The code is L3000 left and right (you need a pair even though only one foot hurts).
With this information in hand you can decide if you can afford custom orthotics.
Now, you raise the question if surgery would be a better approach to your problem. There are surgical procedures available to correct a plantarflexed third metatarsal.
If the problem is "truly" due to your curled toes, then just straightening the third toe may go a long way in alleviating your problem. Without actually examining you, I have no idea if that would be all the surgery you would require.
In many instances, the metatarsal bone is surgically broken and is elevated out of the way.
Here's the rub. There is no guarantee that the procedure will work. In elective procedures or any surgical procedure for that matter, there is always the chance of surgical failure, meaning you might be worse off after the surgery.
So if you have tried the conservative approach first and it does not meet your expectations then taking the risk associated with surgery, has some merit, but my advice, and this is the same advice I give my patients, is to try a conservative approach first.
Lastly, if you decide on orthotics or surgery I would suggest you see another podiatrist. If this guy said he was going to call your insurance company and did not, what kind of service do you think you will get when you are having a problem either with your orthotics or after surgery?

See also surgical considerations


Marc Mitnick DPM
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