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  • Q&A with Australian Health Practitioners

    What is causing the pain on the top of my foot?

    A week and a half ago I walked from the car park onto the grass at work and after a few steps I felt like I had cramp in all my toes. After rubbing it the pain did not ease however after a couple of hours I could feel it only along my second toe. Each time I walked the pain increased and when I was resting it subsided. A couple of days later I went to the Doctor and she sent me for an X Ray which should no signs of a fracture or a break. She prescribed Diclofenac and said to see a Podiatrist.
    I went to a Podiatrist and he said it might be a tendon thing and said to massage it each day and roll a tennis ball under my foot twice a day. I have been doing this and it does not seem to be easing. The pain gets worse when I walk and my foot aches when I am in bed. I can pin point the pain, it is about an inch down from the toe joint on my second metatarsal and when I press it it feels like a bruise. Should I even be walking on it?
  • Find a professional to answer your question

  • 11

    Thanks

    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Mudgee Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    Have you had any relief with the Diclofenac?

    Seems like quite an odd injury mechanism, althought we do tend to see these types of injury from time to time.

    There are many different possibly tissues that may be causing your pain from the joint itself, to the muscles and tendons surrounding the foot and toe. To make a comment on this, I would need to take a thorough history and examine you myself. 

    You have sought a responsible opinion and the care seems appropriate. How long have you been doing the exercises and how long has it been since the injury? Sometimes it may take a few weeks before you notice a reduction in symptoms.

    As for walking on it, you mentioned previously that it worsened with activity and eased with rest. Is this still the case? It may be worth resting the foot for a few days and see how it goes. 

    Failing a trial of conservative care for 6 weeks, it may be recommended that you seek further investigations, such as ultrasound or MRI make a more robust diagnosis.  

  • 2

    Thanks

    misshewens

    HealthShare Member

    Thanks for your answer.  The Diclofenac didn't do a whole lot.  I did the exercises for a week and a half and each time I did them I was in quite a lot of pain.  I ended up going for an ultrasound which showed nothing.  Back to the Dr and he said he suspects a stress fracture and I am now in a CAM boot for a few weeks.  He suggested an MRI but I can't get in for another week and a bit. 

  • 5

    Thanks

    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Mudgee Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    If you are concerned of a more timely diagnosis, a 3 phase bone scan can be done to detect the presence of a stress fracture and usually has a shorter waiting time.

  • 2

    Thanks

    Anthony Short

    Podiatrist (General)

    Anthony Short BAppSc(Pod) MPod hold both Bachelor and Master level degrees in podiatry, and works in private practice, hospital and educational positions within Brisbane. His … View Profile

    There are multiple causes for this. The top of the foot is home to the tarsal bones and numerous small joints, which are prone to osteoarthritis, particularly if there is a past history of trauma or a family history of primary osteoarthritis.
    Additionally there are numerous nerves and tendons that could also be injured. A frequent and common cause of pain at the top of the foot is nerve compression due to ill fitting footwear - this will often cause ‘pins and needles’ towards the toes.
    The foot is also naturally prone to a range of systemic conditions such as rheumatoid arthritis, gout and various forms of peripheral neuropathies. More information about the nature of these symptoms can help narrow the list of possible causes.

  • 1

    Thanks

    Dr Stephen Leow

    HealthShare Member

    The pain doesn't sound neuropathic, but it is difficult to confirm without examination. From the description, I suspect it is soft tissue in origin, but it is prudent to exclude bone problems like stress fracture.

    Are there any conditions which might predispose to neuropathy eg diabetes?

  • Dr Adam Gavine

    Chiropractor

    I am a chiropractor who specialises in Active Release Techniques and instrument assisted soft-tissue treatment. I have a keen interest in everything nutritional as I … View Profile

    The recommendations given by the other therapists are good ones. It is always best to establish a solid diagnosis before undergoing treatment, however, sometimes this is not possible and the test simply rule out certain conditions. It does sound like this is what is occurring in your case. If you've already had an X-ray and ultrasound the likelyhood of finding anything on an MRI or bone scan are quite low. If you are one of those people who like to have certainty, then go ahead and get the MRI.

    It is difficult for us as therapists to help you with this one without a full history or examination. However, if you held my feet to the fire I would suggest that it is mainly a soft tissue problem. It doesn't really sound like arthritis or gout which will even hurt at rest and are often visualised on X-ray. And you didn't mention anything about any neurological symptoms such as pins and needles, numbness or weakness in the foot, so I would suggest that it doesn't sound like a neurological condition.

    There are many joints, ligaments, muscles, tendons, and fascia in the foot that all need to function properly to allow a natural pain free gait. I would suggest seeing a therapist such as myself, that specialises in myofascial treatment such as Active Release Techniques to assess and treat any of these structures that are dysfunctional. At least that's what I would do in your situation.

    p.s. Becareful with wearing a CAM boot, if you don't actually have a stress fracture they can lead to an exacerbation of your condition as you will have effectively immobilised the foot and lead to muscle atrophy and decreased blood flow to many structures in the foot (from disuse) and inadvertently caused increased deposition of myofascial adhesions (scar tissue). All of which are undesireable.

    Hope that helps

  • 2

    Thanks

    Dr Firas Hasan

    Chiropractor

    Dr. Firas is a chiropractor based in Adelaide who is passionate about the spine. His clinic offers a same day appointment and treatment guarantee. Dr. … View Profile

    Aah… Good old mid foot pain. This one always gets me excited as often times the solution is very simple. The mid foot plays a very important role in stablising the weight of your spine, knees and pelvis. The reason why you have pain in the region most likely relates to imbalance. There are three very important arches in the foot and you most likey have a fallen transverse arch. In addition, nerve irritaion in the lumbar spine can make the condition worse. I often start by examining the patients feet for fallen arches, correct the arch issue and also address the nerve issue in the spine. In most cases patients pull up quite well. 

  • Dr Firas Hasan

    Chiropractor

    Dr. Firas is a chiropractor based in Adelaide who is passionate about the spine. His clinic offers a same day appointment and treatment guarantee. Dr. … View Profile

    Aah… Good old mid foot pain. This one always gets me excited as often times the solution is very simple. The mid foot plays a very important role in stablising the weight of your spine, knees and pelvis. The reason why you have pain in the region most likely relates to imbalance. There are three very important arches in the foot and you most likey have a fallen transverse arch. In addition, nerve irritaion in the lumbar spine can make the condition worse. I often start by examining the patients feet for fallen arches, correct the arch issue and also address the nerve issue in the spine. In most cases patients pull up quite well. 

  • Dr Andrew Knox

    Podiatric Surgeon, Podiatrist (General)

    Dr. Andrew Knox is one of the most-highly qualified foot specialists in Australia, holding both a Bachelor of Podiatric Medicine and a Doctorate of Clinical … View Profile

    Sounds like it may be a Morton's neuroma/bursal complex. They are the most common cause of forefoot pain, and typically patients describe experiencing a bruise sensation. Request your GP or podiatrist to send your for an ultrasound scan to investigate further. Kind regards

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