Foot issue
- Thread starter Laurs
- Start date
Again, from a total layman's view (who has seen these kinds of images and gone through 2 successful surgeries), the actual big toe halux valagus doesn't look too bad, which is circled in white, but that weird protrusion circled in red grabs attention. Looks like the joint of the big toe is clean, no spurs, no arthritis in there or anything. Your pain @Laurs is coming from the area between the big toe and second toe, is it not? Could it be from that 'blob' in between there? Dunno. Could a surgeon just clear that out of there?
Hi @jeff, thanks so much for paying such good attention 
, and yes, when i saw the X-rays for the first time at the consult with the first ortho, i also asked about that round protruding 'thing.' She then explained it was like a patella on the knee, i think it's called the sesamoid bone. And yes Jeff, the sensitive part is between toes 2 and 3. I have been doing some research and think it's a good idea to tell the ortho tomorrow that i have had psoriasis since i was a baby, my dad had it big time. I never had it bad, just elbows and knees when i was small, and scalp and big toe nails (half way only) when i was in my 30s. Though when i went completely gluten free, it all went away, more or less. I want to ask him if it's a good idea to explore if it could be psoriatic arthritis, i understand that there might be an indication from X-rays and MRI, and they can do further tests, blood and joint fluid, to confirm.
, and yes, when i saw the X-rays for the first time at the consult with the first ortho, i also asked about that round protruding 'thing.' She then explained it was like a patella on the knee, i think it's called the sesamoid bone. And yes Jeff, the sensitive part is between toes 2 and 3. I have been doing some research and think it's a good idea to tell the ortho tomorrow that i have had psoriasis since i was a baby, my dad had it big time. I never had it bad, just elbows and knees when i was small, and scalp and big toe nails (half way only) when i was in my 30s. Though when i went completely gluten free, it all went away, more or less. I want to ask him if it's a good idea to explore if it could be psoriatic arthritis, i understand that there might be an indication from X-rays and MRI, and they can do further tests, blood and joint fluid, to confirm.
Ok, the sensitive part is this marked in green?:
It looks like there is a lack of space between those toes, and maybe something attached to the bone (if only SRT could get rid of that!
)After reading Polly's horror story and reading other replies, I don't want to encourage surgical intervention right now either. Those injections plus DMSO sound very interesting albeit somewhat challenging in terms of procuring the proper needles and Quinton solution in addition to regularly poking your foot
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I think so, but I think the ortho said also the little piece in the proximal phalange bone underneath the spot you marked, which is almost touching the proximal phalange of toe 3. Yeah, no surgery at this point for sure and do all the necessary to get a definitive diagnosis, and of course I continue with the proper anti-inflammatory diet and keep on walking, swimming and yoga-ing. Luckily, the weather here is still excellent. Thanks Jeff!
The sesamoids are right where they belong, being part of a tendon system. What has happened is that the 1st metatarsal has gradually moved "inward". Instead of its head being centered over the sesamoids, it is now 'off-center', and severely so. That muscle/tendon system is now functioning like a bow string to reinforce and induce progression of the deformity. The only fix for this is surgery to restore the metatarsal position. That doesn't mean that you need to have surgery, only that surgery is the only possible way to correct the issue. This is an extremely common finding. Most people get on well with this problem.
The deformity is cause by many years of over-pronation while walking.
It looks to me like you may have some instability in the area of the Navicular/1st cuneiform joint, but only a physical examination and gait analysis would tell for sure. If so, this would very definitely contribute to over-pronation.
Are you having any symptoms in front of your ankle? It looks like your anterior tibial plafond may be under some stress.
Here's an image with correctly aligned sesamoids:
Understand that feet are as unique as faces. As far as bunions (Hallux Valgus) being hereditary, I've never heard of a gene coding for this. What is inherited are osseous shapes and alignment patterns that predispose one to developing such a deformity.
The deformity is cause by many years of over-pronation while walking.
It looks to me like you may have some instability in the area of the Navicular/1st cuneiform joint, but only a physical examination and gait analysis would tell for sure. If so, this would very definitely contribute to over-pronation.
Are you having any symptoms in front of your ankle? It looks like your anterior tibial plafond may be under some stress.
Here's an image with correctly aligned sesamoids:
Understand that feet are as unique as faces. As far as bunions (Hallux Valgus) being hereditary, I've never heard of a gene coding for this. What is inherited are osseous shapes and alignment patterns that predispose one to developing such a deformity.
Thank you very much @Yupo for your analysis, it helps a lot to explore what more i can do. When you say 'Most people get on well with this problem,' do you mean they get on well without the surgery? I don't have any problems in front of my ankle, yet, but from what you write and from what i just read about over-pronation, it would seem that looking into my gait, or at least have a video gait analysis, would be a first step now. I was thinking that this over-pronation may also cause, at least some, of my regular knee pain (which I've had for 26 years already). So, I'll see what the ortho has to say this afternoon, and do some research for a good podiatrist. Once again, many thanks for taking the time and effort to help me, I'm very grateful!
You are most welcome. I mean that (in my experience) most people with HAV (aka bunion deformity) do not need surgery to be comfortable, function well or to find suitable (and even stylish) shoes. HAV is really a whole foot issue with many influences including degree of ligamentous laxity, so every case is unique. I have seen congenital HAV, but only once. The most painful period in bunion development is the earliest phase. Also, oftentimes what hurts isn't the bunion, but entrapment of a cutaneous nerve branch well proximal to the joint. Such things need to be ruled out before assuming it is the bunion that is the (pain) problem. I could go on and on.
I had my Left foot fixed about 20 years ago, more for balance and functional improvements than for cosmesis. Basically, as a foot professional I knew what was coming my way if I didn't address these issues (even though I wasn't in any pain). I required a gastroc recession, a Cotton insertional wedge osteotomy and a tri-plane Austin procedure to get the foot I wanted. Never missed a day of work (but probably should have!). It helped a lot that I was a on a first name basis the best foot surgeons. I would never recommend surgery to a patient without significant pain. And I would ALWAYS try at least a year of aggressive but more conservative care first.
If you're in USA or Canada, I'd strongly recommend seeing a podiatrist for such care, but I'm being up-front about my bias. We do the vast majority of the foot surgery done in these regions, and so are IMO the better trained and experienced. In other parts of the world, podiatrists have a much more narrow scope of practice.
Here is a good video overview of foot biomechanics, albeit with a sales goal in mind.
On their channel are some shorter videos about particular foot problems which explain the mechanical faults leading to common problems. If you want to go all in, the longest videos are some of Dr Glasser's academic lectures. I met him at a conference and used his devices for many of my adult patients to very good outcomes in my practice. I took care of a lot of young military members who were forced into over-use as part of their jobs.
I'm on a rant now...
One thing that frustrated me was the lack of support from pediatricians for early mechanical intervention. They would tell parents (quite honestly) that they'd never seen bad outcomes from letting children develop naturally, so better to see how they do. But, they didn't see these children at age >40, with progressive knee, hip and spinal degeneration! A clue might have been to have a look at their parents, but I digress.
I had my Left foot fixed about 20 years ago, more for balance and functional improvements than for cosmesis. Basically, as a foot professional I knew what was coming my way if I didn't address these issues (even though I wasn't in any pain). I required a gastroc recession, a Cotton insertional wedge osteotomy and a tri-plane Austin procedure to get the foot I wanted. Never missed a day of work (but probably should have!). It helped a lot that I was a on a first name basis the best foot surgeons. I would never recommend surgery to a patient without significant pain. And I would ALWAYS try at least a year of aggressive but more conservative care first.
If you're in USA or Canada, I'd strongly recommend seeing a podiatrist for such care, but I'm being up-front about my bias. We do the vast majority of the foot surgery done in these regions, and so are IMO the better trained and experienced. In other parts of the world, podiatrists have a much more narrow scope of practice.
Here is a good video overview of foot biomechanics, albeit with a sales goal in mind.
I'm on a rant now...
One thing that frustrated me was the lack of support from pediatricians for early mechanical intervention. They would tell parents (quite honestly) that they'd never seen bad outcomes from letting children develop naturally, so better to see how they do. But, they didn't see these children at age >40, with progressive knee, hip and spinal degeneration! A clue might have been to have a look at their parents, but I digress.
That "blob" isn't a problem, or so easy to remove.View attachment 101024
Again, from a total layman's view (who has seen these kinds of images and gone through 2 successful surgeries), the actual big toe halux valagus doesn't look too bad, which is circled in white, but that weird protrusion circled in red grabs attention. Looks like the joint of the big toe is clean, no spurs, no arthritis in there or anything. Your pain @Laurs is coming from the area between the big toe and second toe, is it not? Could it be from that 'blob' in between there? Dunno. Could a surgeon just clear that out of there?
You might have a nerve entrapment, which is extremely common. More common in Right foot in UK and Left foot in USA. I have a pet theory about clutch use which might explain the pattern. We did a cadaver study on these problems in school, finding such lesions in about half the feet we looked at. Most were asymptomatic, I'd guess. Sort of like a problem just sitting there, waiting for enough of an insult/trauma to flare them up.Ok, the sensitive part is this marked in green?:
View attachment 101036
It looks like there is a lack of space between those toes, and maybe something attached to the bone (if only SRT could get rid of that!
After reading Polly's horror story and reading other replies, I don't want to encourage surgical intervention right now either. Those injections plus DMSO sound very interesting albeit somewhat challenging in terms of procuring the proper needles and Quinton solution in addition to regularly poking your foot
meadow_wind
Jedi Council Member
I would say thanks to you! Because this thread is really helpful. Every time I have a problem, I come to the forum and find help one way or another. It's amazing :) France's exercise might help us a lot (my daughter and I)
Speaking of rants, I noticed my daughter's knees were problematic when she was 3 yrs old: going toward knock knees caused by an almost flat foot. I was referred to a "specialist"... An old ignorant that told me to "wait, it will fix itself as she grows up". I knew it was a lie, and so the problem is still there, but less pronounced. She's almost 12 now, so I think it could be improved by doing specific exercises.
As for me, I am experiencing numbness on the outside of my big toe on my right foot. Under the toe, there is a buildup of callus that the other foot does not have, due to the distribution of my weight when I walk, and it is made worse if I wear certain types of shoes/sandals. I have an appointment with my doctor in 2 weeks to discuss this and request x-rays and a referral to a podiatrist. Do you have any suggestions on this?
meadow_wind
Jedi Council Member
Montreal, Qc
So last night I had the consult with the ortho to discuss the MRI results: osteoarthritis it is, and surgery is off the table. He prescribed 30 days of taking the anti-inflammatory Etodolac, 2x p/d 300mg, and advised me to get good insoles. Upon my asking, he stated that he didn't know if it was psoriatic arthritis or osteoarthritis and that it didn't matter for now. He also didn't show curiosity why this manifested in a otherwise healthy, slim person of 54 years of age (i.e. much yonger than the "normal" onset of this type of affliction, and was more like, yeah, tough luck, don't go play tennis anytime soon! Yeah, right!
We went to the ortho centre today for new insoles, but the lady said that the ones i got last time would not differ much from other ones, same material etc. I wasn't already impressed with those, and glad that we walked out because after watching the video Yupo posted above, it would seem logical for me to get a pair as described in the video: with good, solid arch support and all (thanks Yupo for posting it!). So, now i will get myself an appointment with a podiatrist here, who i read did her studies in the US (i am in Portugal), do a video gait analysis and see what she has to say about getting the correct insoles. I do think though that i would have to go to Holland to have them made there. The first ortho mentioned that the quality in Portugal is quite poor.
At the pharmacy, the helpful guy said that he advised taking each Etodolac pill with the stomach protector Aboco NeoBianacid, which is gluten free and plant based. I read some disturbing side effects relating to Etodolac (other name is Lodine), so I think it might be useful to take the Bianacid as well. There is some inflammation on top of the bone under toe 2, so I really hope it will go down with this drug. As per Laura's post here, i will start taking omega-3 and quercetin again to help counter the inflammation, as well as up the Vit C. If anyone has experience with or comments about Etodolac, I'd love to hear about it. Many thanks!
We went to the ortho centre today for new insoles, but the lady said that the ones i got last time would not differ much from other ones, same material etc. I wasn't already impressed with those, and glad that we walked out because after watching the video Yupo posted above, it would seem logical for me to get a pair as described in the video: with good, solid arch support and all (thanks Yupo for posting it!). So, now i will get myself an appointment with a podiatrist here, who i read did her studies in the US (i am in Portugal), do a video gait analysis and see what she has to say about getting the correct insoles. I do think though that i would have to go to Holland to have them made there. The first ortho mentioned that the quality in Portugal is quite poor.
At the pharmacy, the helpful guy said that he advised taking each Etodolac pill with the stomach protector Aboco NeoBianacid, which is gluten free and plant based. I read some disturbing side effects relating to Etodolac (other name is Lodine), so I think it might be useful to take the Bianacid as well. There is some inflammation on top of the bone under toe 2, so I really hope it will go down with this drug. As per Laura's post here, i will start taking omega-3 and quercetin again to help counter the inflammation, as well as up the Vit C. If anyone has experience with or comments about Etodolac, I'd love to hear about it. Many thanks!
Thank you once again Yupo for your helpful post. What an ordeal you went through! I bet your foresightedness and action prevented many problems which would only manifest at a later stage in your life. I wanted to ask if by "at least a year of aggressive but more conservative care" you mean, amongst other things, taking NSAIDs like Etodolac (and stroner ones)?
I know! This forum is a true life saver in so many respects! I'm really happy you get so much out of it, and i hope the podiatrist can help you with your big toe issue, good luck to you!
