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The response to the question below was authored by Marc Mitnick DPM
Top of foot under ankle above heel
by kevin
(us army Germany )
I'm a soldier in the army and have been dealing with an excruciating pain in my foot for apx 2 years without relief. The origin of the pain is at times extremely hard to pinpoint because of how intense the pain is at times. It feels as if something is shooting extremely fast from top of my foot to just under right ankle to back of foot approximately 1/2 inch above heel. It comes in episodes on and off after training events. Even after something as simple as a slow jog for a couple miles sets it off. The pain arrives fast and very intense. Sometimes after a more intense exercises such as hill sprints with about 30 pounds of weight or 12 mile road marches with about 50 pounds of weight the pain is demobilizing and so excruciating to the point of feeling helpless. After about 1 hour the pain starts to dissipate alot until I rest or relax and out of nowhere the pain returns in full effect. I have tried everything to fix issue but it never gets better. Xrays show nothing physical therapy helps for very short time. After an episode is brought on there is constant pain for up to as long as a week with the first couple days being the worse. I can't walk I can't apply any pressure or even flex my foot without horrible pain. Looking at my foot after an episode seems normal maybe minimal swelling at most but one thing I do notice is all the vains on the top of and side of my foot seem to be inflated and pulsate with the pain.
RESPONSE
Hi Kevin,
I would like to think that a pain that is over two years old and not getting better, needs further investigation.
Quite frankly, I am surprised that you are able to carry on your
I could begin to guess and give you a number of possible reasons why your foot hurts, but that would be all I am doing.....guessing.
It is obvious to me that you require a more extensive examination of your foot. The first thing I would recommend would be an MRI and if that is not possible, then at the very least a CT scan of your foot.
Either one of these imaging techniques will reveal far more pathology than an x-ray can reveal. In the mid part and the rear portion of the foot, the bones have a tendency to overlap and so at times it can be difficult to evaluate each bone simply through an x-ray. Additionally, an MRI will also reveal any soft tissue problem that may be the source of your pain.
You are young, probably in good shape, healthy, have had physical therapy, by your own admission have tried various things to redue the pain, and have had two years for any simple problem to work its way out. But, you still have pain! The only thing working against you is that you are constantly putting the painful foot under a lot of stress and that can delay healing in what for most people would be a simple musculo-skeletal problem.
In the non-military world you could rest the foot by going non-weightbearing and using crutches for a few weeks to see if that eliminates the problem, but I am guessing that is not an option for you, so you will have to rely on additional imaging procedures to try and find out what is causing your foot pain. Quite frankly, it is easier to treat a problem when you have a proper diagnosis than it is to just guess at what might be causing your pain.
Marc Mitnick DPM
DISCLAIMER
ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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