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The response to the question below was authored by Marc Mitnick DPM
Sprain, 2nd mtp synovitis, fibular sesamoiditis
by ljb
I was diagnosed with a sprain, contusion, 2nd mtp synovitis, and fibular sesamoiditis. This was not a gradual thing as so many sites say. (And rarely wear high heels.) I would call it a traumatic event. I had no pain in foot or forefoot in many years. I was riding my bicycle with my son's trailer attached. Sometimes to get myself going, I will push off a curb. I was wearing running shoes of a well-known brand that are wider in the toe area. . .perfect for me. I maybe pushed off too hard three weeks ago. I felt crackle snap pop kind of below my first second and third toes, but in the ball of my foot. Immediate explosion of pain. For the first seconds I thought I'd fractured toes, because the pain went up, and also felt it almost down to my heel. As it subsided a bit, I realized that I could move my toes themselves without pain (also having had a confirmed broken toe years ago gave me something to compare to.) I could notwalk on it, and even on my heel, felt/feels like pain is still pulling in one line from up below big toe. . .the sesamoiditis? Anyway iced a lot the evening. Husband got out my crutches from other iniuries several years prior. I stayed off. Took advil, but irtitates stomach. Anyway, had xrays twice. All they could see was no fracture. I was given a short boot to wear for two weeks. And told to wean off the crutches, and I would never have to come back because it would heal. I am still on crutches because even in the boot I can still barely tolerate placing weight on most of my foot. I have a young son, and if he has even accidently touched my foot, I cry because the pain was do bad. Even in the boot, I realized that when I stand, I keep trying to put all my weight to the outside of my foot, which isn't great, because of a
So, after three weeks, should I just continue resting my foot? It feels better with the support of the short boot, but walking even somewhat normally still kills. And pain in bed without the boot still wakes me up early in the morning. (pressure from sheets hurt sometimes.) I am still icing regularly. Will it just take more time than the (rather dismissive)dr seemed to think? I am starting to get frustrated. And a young son who wants to run. Should I get a second opinion?
RESPONSE
Hi,
I cannot imagine what you could have done by pushing off the curb with your foot, especially since you were wearing shoes. Snap, crackle, pop and a lot of pain suggests to me that you did something very weird in a simple motion.
If all you have is a synovitis and fibular sesamoiditis, I would think after three weeks in the boot you should be at least 50 percent better. If you are not, then there may be more damage here than suspected.
You have a couple of options here. You might want to consider an MRI which will give you a more complete view of what is actually going on in your foot; the fact that the pain traveled all the way back to your heel suggests a problem worse than the diagnosis you have been given. Synovitis and sesamoiditis should only yield pain in a small confined area. If the pain is traveling then you have to rule out tendon or muscle damage on the bottom of the foot. An MRI would reveal that damage.
If an MRI does not show much beyond your original diagnosis, then I would ask the doctor to give you a prescription for physical therapy, to move your healing along.
Marc Mitnick DPM
DISCLAIMER
Comments for Sprain, 2nd mtp synovitis, fibular sesamoiditis
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ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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