Sesamoiditis? Capsulitis? Metarasalgia? HELP!

by Carol
(Colts Neck, NJ)

For 4 1/2 years I've been suffering. It started with sharp pain under the pad of my big toe and I was initially treated for sesamoiditis. After a year of no relief, cotisone shots and ill fitted orthotics, I had a sesamoidectomy. Trouble is, in that time I started having severe burning on the base of my second metatarsal joint, which I was told was probably a neuroma (which was also "removed" at the time of my sesamoidectomy). The surgery gave me no relief of either. A painful year later, I had my second surgery to "clean up" and "see what was going on". They cut back the original neuroma and removed a deadened nerve and saw I still have one sesamoid bone in my foot but left it in. Again, no relief. I've gone to neurologist, physical therapy, 2 years of pain management involving numerous ultra-sound guided injections as well as "free hand" injections, hundreds of dollars spend on gel cushioning of every kind, felt padding, to separators, wearing flat shoes only with thick soles (90% sneakers). I've been to 3 podiatrists, 2 orthopedic surgeons, acupuncture, reike, chiropractor (let me mention I have a bulging disc and a herniated disc)and a neurologist. I just recently had my third surgery in which my dr. shortened my big toe to help with the structure of my foot to relieve the sesamoid load. It is 2+ months later, and my foot is worse than ever. BURNING on the center ball of my foot as well as under the second joint, and the PAIN of feeling like I'm stepping on a nail. Over the past two years, the symptoms are also coming and going in my other good foot, painful sesamoid area and burning in the metatarsal area. I don't know how much longer I can take this and am fearful both feet will soon be un-walkable. I NEED GUIDANCE.

RESPONSE

Hi Carol,

The first bit of guidance I can give you is STOP having surgery every time a doctor recommends another procedure. The problem with multiple procedures in the same confined area is that we as surgeons come no where close to the "man upstairs" in designing human anatomy.
What this means is that every time some one takes a scalpel to your foot they make things worse for two reasons. One, they try to remove body parts that were put there for a reason and two, each and every procedure you have leaves you with more and more scar tissue which only makes matters worse, including loss of motion in the adjacent joints and thickened skin which only causes more pain on the bottom of the foot.
Scar tissue does not function like normal tissue and the more you have, the worse your condition becomes. Even if a doctor recommends more surgery to "clean out the scar tissue" I would advise you to pass on that option.
So what are your options?
One option is to face reality and understand that you have a foot problem that will not be remedied by surgery and that you are stuck with all the additional problems that surgery has caused you.
You will need special orthotics or innersoles, but when I mean special I do not mean a typical custom orthotic. I mean you will probably have to find a custom shoe/orthotic maker who can fabricate a device that address's all the issues involved.
That would include cushioning the foot particularly wherever there are any bony prominences as a result of all this surgery.
In addition the orthotic would need padding built in to it to redistribute body weight away from the painful area. This is not a device someone can just slap together. It will take testing and re-testing until it is perfect enough to allow you to walk with some degree of comfort.
I am basing my suggestion on the fact that I have seen this situation quite a few times over the years. People continually consenting to surgery in the same area in an effort to fix what was previously done, only to end up worse. The fact that you have been to podiatrists and orthopedists allows me the comfort of knowing that some obscure problem probably has not been missed and that you are the victim of poor advice.
I wish I could be more optimistic, but sometimes there are medical problems that cannot be cured; the patient has to learn to adjust to it.

Marc Mitnick DPM
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