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Q&A with Australian Health Practitioners
Who should I see if a foot problem is ongoing and getting worse?
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I have an extremely sore spot on the plantar aspect medially of the big toe MTP joint. Have had for 6 months. A scan shows small effusion of the area and odema between 1st and third web spaces and around sesamoid. All other results of foot health are normal including arthritis (osteo but normal for my age of 53) but I am in extreme pain all the time ie from the moment I get up.
It is also affecting my other foot in same area though the tender spot is not there.
- I have had a cortisone injection which was heaven for 3 days and then the pain and burning returned.
- Physio and massage have been abandoned as they make the pain worse.
- Aspro clear gives me some relief sometimes but I am taking it too much. - - Panadol or codeine were of no benefit.
- Anti inflams make my head crazy!
- Have foot dome.
- Have had orthotics many times over the years.
It is three months before I can see an orthopaedic dr who specialises in feet but am wondering if travelling a long distance to see him is even worth while? -
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Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
Have you seen a podiatrist?
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Thank you for replying. Yes I travelled to sydney and saw a podiatrist. I liked the orthotics but this problem developed after wearing them as told for 6 months.
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Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
Sounds like quite a difficult situation.
On occasion our practice has been called into consult on cases such as this. There is the possibility that this may be a situation similar to that of a growing body of research around non responsive issues such as this in which they are finding that although there is a local injury (as is obvious with the scans you have had) they fail to appropriately resolve in a normal healing window. The thought is that the central nervous system becomes sensitised to the injury so that even non damaging sensations are perceived by the brain as painful.
It is probably worthwhile seeing the specialist to see their opinion although current guidelines suggest conservative management before surgical intervention. I can't comment for other professions, however it may be worth an opinion from a chiropractor in your area.
You can search on www.chiropractors.asn.au for one near you.Report this post
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Thank you. I appreciate your time and response.
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Well I haven't quite lost my sense of humour so am having a Friday night beer. Is that an Australian response?
And seriously…. what you say does make sense. Sadly I have also seen a local chiropractor. Have been a client for years. But this seems to be a hard one. Somehow the nerve in that area seems to be irritated…. if that makes sense.
Never ever ever give up!Report this post
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6
Thanks
Dr Ryan Hislop
Chiropractor
Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile
Not a problem, hopefully a solution can be found for you soon.
All the best,
RyanReport this post
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Jacqueline Kan
Podiatrist (General)
Cheltenham Podiatry offers excellence in all areas of footcare.From corns, callouses, fungal nails to sports injuries, Diabetic foot care, ingrown nails and orthotics. Full gait … View Profile
You could have a bad case of sesamoiditis or even a stress fracture or fracture of one of the sesamoids is a possibility. Apply ice for 10 mins or so , if deep pain increases this can be a sign of fracture. This this may be worth ruling out with some diagnostics,also do you have bunions where the 1st M.p.jt protrudes and big toe angles towards smaller toes as this will cause lots of pressure from footwear, and aggravate joint pathology.
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Thank you for your response. Sesamoiditis was certainly suggested but the time has passed and I have seen the specialist orthopaedic surgeon was quickly was able to diagnose a tear in the plantar plate under the second metatarsal. He certainly knew all the places to touch. So reluctantly I am having surgery next week. I certainly tried all conservative methods.
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Jacqueline Kan
Podiatrist (General)
Cheltenham Podiatry offers excellence in all areas of footcare.From corns, callouses, fungal nails to sports injuries, Diabetic foot care, ingrown nails and orthotics. Full gait … View Profile
Well now you have a clear diagnosis, so I assume you have tried the appropriate padding for plantar plate,that is a 3-4mm thick pad (poron material, which is equivelant to sorbothane quality)across the whole ball of the foot(we call it a plantar cover,which is bigger and different to a dome),the idea here to to have full thickness under the ball of the foot, where all the M.P.jts have the benefit of a full thickness pad.The logic is that a tear in the plantar plate will allow the joint to push through the tear plantarly causing your pain.Having a full thickness durable pad under the 2nd .M.P.jt, would push the joint back into position dorsally,so the tear is not irritated by a plantar protruding joint, this reduces pain and wearing it full time then allows the tear to heal. I have had repeated success with this. If it works for a period of several weeks, in some situations i have then incorporated the pad into an orthotic. The patient wears it daily. The pad must be sufficiently thick and of durable material,not the really cheap stuff that flattens with several weeks. I guess it might be worth trying a pad on its own, unless this type of pad was already tried. If so, good luck for the surgery.
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Thank you. Great advice and maybe if I had been able to try something like that a while ago I could have avoided a miserable year and surgery. However it seems “all” has gone too far, I am over being unable to walk without pain. Oh well! Here goes the dreaded surgery. However it is great to know about your treatment as I know I will hear of someone else who has the problem and hopefully they will get a diagnosis quicker than I did. Country medical services!
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