Severe pain; can't bear weight on right foot

by Dawn
(Indiana)

For the 4th time in my life, my foot started hurting again tonight, following the same progression of symptoms to the point of severe pain and inability to walk on the foot. The first time this happened has been within the past five years. I have no recollection of injury or of doing anything (movement or intensity-wise that would account for it) to my foot.

My foot begins to hurt in the early afternoon to evening, with the pain progressing as the night wears on. With attempts at weight bearing, it becomes excruciating and it is impossible to bear any weight. If I sit with my foot elevated, the pain is just a dull but constant "throbbing" sensation which is tolerable. If I dangle the foot, the pain increases to the point I need to elevate it again. There is an area of redness and swelling that appears to be worst on the medial aspect of my right foot and extends a bit to the plantar surface.

The first and second times this happened seemed to be the most severe, in terms of pain. Possibly because when I know it is coming on now, I stop whatever I'm doing and make arrangements to get home and get my foot elevated until morning. However the first time, I could not sleep through the night, even with my foot elevated high because of the intensity of the pain.

The pain reaches its height at night; by late morning to early afternoon of the next day, it is like nothing ever happened! The pain, redness and swelling recede and no matter how much I go back to working my foot, the pain and the other events don't come back for a year or more. For that reason, I have been unable to show this to the doctor WHILE it is occurring, but he suspected plantar Fasciitis. I don't think what is going on follows the usual script or place, for the pain and swelling location, though. I thought maybe I had been bitten by a spider or other insect, since I wear a lot of casual shoes in our basement and while gardening.

The weird thing (to me) is that the redness, swelling and pain are ALWAYS in the exact same location on the same (right) foot. The pain ALWAYS starts in afternoon and reaches a peak at night. And the next morning, with no more treatment than rest and elevation, everything goes back to normal. I don't have any other symptoms that I notice. Thank you for any help you can provide in figuring out what is going on!

RESPONSE

Hi Dawn,

So....what we know is that this excruciating pain occurs for no apparent reason within 24 hours it is gone.
The most common condition that would cause this set of symptoms would be a gout attack. Gout is an accumulation of uric acid in a joint which basically irritates the joint and causes severe pain along with redness and mild swelling. It will last for period of time ranging from one day to a few days, but in most cases is self limiting, meaning it just goes away. Read my section on gout for full details of this condition.
A second possibility would be an inflamed bursal sac, commonly known as bursitis. We usually do not see bursitis in this section of the foot, but if a certain pair of shoes is creating enough pressure or irritation, it could flare up this section of the foot and cause similar symptoms, but I have to say based on your picture, the redness (and probably the pain) would not be as intense.
The chances of it being plantar fasciitis or possibly a tear of the abductor hallucis muscle are very, very remote for the simple reason that they would just not subside in 24 hours. In fact most musculo-skeletal injuries would not subside in 24 hours particularly those that are as painful as the symptoms you describe.
Ask your doctor to check your uric acid levels for gout, but be aware that during an actual gout attack, the uric acid levels may be normal.

Marc Mitnick DPM
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