Foot problems

[chrisqld]

Hi all, I trust you're all well and good. Look, I have a problem and thanks for allowing me to post on this here forum. I'm from Queensland and recovered from a chronic illness over the last few months. Maybe my feet weren't conditioned enough I don't know. What's happened is I built up my walking until I was doing around 40km to reach an average walk of 50km a day. About a month ago I got this bad pain in my right foot. For a few days I could hardly walk, then it was kinda ok so I did a mountain and a little running, gym etc, and it got much worse. The other week it landed me in hospital. The pain was so intense I had to splint the leg up to the knee. Xrays show no broken bones. Doctor said it might be muscle damage, ligament or a tendon problem. They're not sure.

It's been about 4-5 weeks since I've walked for more than a couple of kilometers and I'm frustrated and trying to get out. Can't do much until I get this foot fixed. I'm a new hiker and looking for advice. I currently rest (and have rested and rested til the walls close in), ice a lot, compression, elevation for the foot, use Voltaren gel, and I find running my foot over a golf ball helps the arch, at least, takes away some of the strain. I've seen three doctors who can't give me an answer as to exactly what I've done and how to treat it and prevent it recurring.

Do you have any suggestions how I can get this foot better? I'm hoping someone here's had the same problem. The worse area is about an inch below the ankle on the far right, above the blade edge of the right foot. It's swollen and there's pain through the front and underside and I get shooting pains up the ankle. I haven't been able to put full weight on for many weeks and I'm elevating my leg most of the time. Also, any suggestions how to improve my foot and ankle so it doesn't happen again?

Sorry to throw this at you. My fitness level was just getting to the place I wanted it to be and this hurdle's becoming a bit much to overcome without a little help.

I'm new to hiking. I stare at my equipment and sigh.

[neilmny]

Go to a good podiatrist, maybe with a sports bent.
I had pain in my left foot which got to the point I couldn't even stand without it aching
badly. It turned out that I have a Mortons Neuroma http://foot.com/site/foot-conditions/mortons-neuroma
Orthotics specifically made for my feet have fixed the problem and I've had no further problems.
The orthotics have also helped my back and posture. Pretty amazing that such a simple although technical thing
could fix the problem. They were expensive but worth every cent.

[wayno]

could be a stress fracture, you need a special scan to show them up normally.... very painful when you put stress on the affected area.... if it is , then staying off it as much as possible for several weeks would normally do the trick but i think bad ones can take longer to heal....
i'd second the podiatrist... and or a physio, someone who can analyse any defect in your gait or footwear that may have caused the issue..
when you get back to walking , i'd avoid walking long distances every day.... alternate what you're doing, at least cut the distance in half every second day and take a couple of days off a week with only short walks...
even top athletes do, hard day, easy day training regimes to give the body a break so they can train optimally. you're just asking for trouble doing long walks every day.... you cant avoid it on trips but its best to give yourself more of a break between trips to avoid the sort of problem you have now...

[Hallu]

Do you have clinics/hospital for athletes like we have in France (we call it sport medecine, and everyone can go, it's for injury related to intense effort) ? If yes, I suggest you visit one. They're specialized in that kind of injury.

[Giddy_up]

What sort of shoes/boots do you use and could the last be to stiff or flexible for your walking/running style.

I read a book about the Japanese and their old culture and there was a bit on foot binding which they did. Symptoms sound very similar, so you may be forcing your foot into an unnatural position which tortures all the ligaments and muscles.

But I would be heading off to something like Hallu suggested and take your shoes with you.

[andrewa]

Suggest you either go back to your doctor, or find a new one.

It sounds like you either have tendinitis/tendon tear in perineus brevis/longus/tertius, or a stress fracture. Tendon tears etc are diagnosed by ultrasound, and helped by cortisone injections under ultrasound control, and various podiatric adjustments. Stress fractures a diagnosed by bone scan, or CT, and have to fix themselves, but are managed reasonably well with a cam walker for 4-6 wks.

This shouldn't be too cerebral for your doctor, unless they are a nimwit. Mind you, I'm not sure why they organised a plain XR. The likelihood of finding anything abnormal based on your symptoms is minuscule.

Andrew A ( I'm a GP)

[Ellobuddha]

I had a similar issue in my foot which was from kicking a dog (long story) i went to the Dr and got sent for an xray which Dr said showed no break. Put up with it thinking I was being a sook. Pain was up in under arch whenever I put weight on it. Felt like a stress or small fracture to me.

Went kitesurfing with it a few weeks later. Pulled a jump and landed board too flat BANG felt it again. Hobbled up the beach. Ended up going to the hospital.

Dr on duty was the same I had seen before. He said it was muscular and to rest it. Remarkable diagnosis seeing he was looking at me through a small counter window and couldn't see me from waist down.

Went to another Dr in despair. She was a lot more interested and actually examined my foot. She was of the opinion that it was most likely a small fracture given the way that injury occurred then reoccurred or not actually mended. She basically told me I could go and get a proper scan to confirm it and pay $$$$$$ with the outcome still being the same. That being rest it or a moonboot at best. Took the advice and gave it a rest for a month and no problems since. Was a long 4 weeks but worked.

Shop around - Drs are like mechanics. Some great some crap. No offence to above Dr. Sounds like a good one.

[chrisqld]

I sure appreciate all this advice. The Xray was done when I went to hospital so it wasn't an organised thing. It's good other people have had this problem though. Sounds like continued rest is needed and I'll re-assess in a few weeks. Start a new job in a couple of days so it'll be difficult. I've been wearing my hiking shoes whenever I go anywhere for that extra support. I recently bought Colorados because my old shoes were a bit worn out which probably didn't help. My third doctor didn't examine it and gave me some advice, too.

Sounds like I should see a podiatrist as well so I'll count my pennies and see one. This was an intense pain and it wouldn't be good to recur a day or two into my next hike. Thanks all I appreciate it. I had no luck with doctors and like Ellobuddha I felt like a big sook.

[andrewa]

In terms of outcome, if someone thinks the likely diagnosis is tendonitis/ tendon tear, then an ultrasound is a worthwhile investigation to prove it as you can then usefully treat it with an ultrasound guided cortisone injection.

In terms of proving that someone has a stress fracture, using nuclear scans/CT/MRI, none of these ( expensive) investigations alter the outcome or management. Rest and cam walker fix it. Mind you, rest and cam walker would probably also fix tendon issues too, but cortisone injection can alleviate symptoms a lot quicker ....or platelet rich plasma (PRP) if the ultrasound proves a tendon tear, rather than tendonitis, but lets not go there..

At the end of the day, an investigation should really only be done if it alters the outcome....some people are happy to pay for nuclear scans/CT/MRI to prove stress fractures, only coz it proves the diagnosis, and allows them to plan their recovery.

A

[GPSGuided]

4-5 weeks since, so a repeat plain X-ray at this stage would show the callus if it was stress fracture. I agree that it's a bit pointless to go for a nuclear or MRI scan at this stage. Bottom line, the problem will necessarily be bone, joint or soft tissue (tendon/nerve). The shooting pain suggests to me it's a nerve issue. I too suggest a medical second opinion. In the mean time, rest up.

[chrisqld]

Thanks GPSGuided. I'll rest up a little while longer then see my 4th doctor if it persists. I just want to get back on my feet but this has been a good lesson in footcare, too. Found some foot and ankle exercises I'll do, too, and probably spend more time on this computer looking at foot care and better things to wear when walking. Good forum this. Sure is helpful.

[Strider]

Do you have clinics/hospital for athletes like we have in France (we call it sport medecine, and everyone can go, it's for injury related to intense effort) ? If yes, I suggest you visit one. They're specialized in that kind of injury.

Is a normal hospital not good enough? Weird. What other specialised hospitals do they have?

[mikethepike]

Hallu wrote:
Do you have clinics/hospital for athletes like we have in France (we call it sport medecine, and everyone can go, it's for injury related to intense effort) ? If yes, I suggest you visit one. They're specialized in that kind of injury.

Is a normal hospital not good enough? Weird. What other specialised hospitals do they have?

Hi Chris. For your type of injury, No, I seriously doubt that a general hospital is good enough. You need to find an individual specialist or place that will really look after your interests. Yes of course you will pay, but it will be worth it. Sportsmed eg deal a lot with sports injuries and have a range of specialists, one or more of whom may need to be involved in getting your foot right. Alternatively of course, your foot might make perfect recovery with rest alone but that means you will need to be patient. The possible problem here is that, depending what the problem actually is - and IMO this is where a good diagnosis would be valuable - early appropriate intervention could possibly prevent a poor outcome and it would also let you know what you may need to do to avoid the problem cropping up again. I speak with the experience of someone who has been on crutches for the past seven months and with no quick end in sight following a severe foot injury. Yes I am being treated in the public hospital but in this case it is an obvious trauma injury which makes public hospital treatment appropriate and certainly the cheapest place to be. It can be occasionally frustrating maybe, when I sometimes wonder if the hospital has much concern that I walk more than most people (and hence value my feet a lot more - at least IMO) but I believe their ethics is to treat people as they would want to be treated themselves. Despite this, I don't believe that public hospital treatment is right for your situation at all Chris. You need a diagnosis and I would recommend Sportsmed or similar and you can make an appointment direct.

[vagrom]

Sudden, frightfully sharp pains in a foot that seem to come and go or are hard to localize to one, pesistent spot. Likely not your problem but don't discount a bit of Gout.
At it's worst I could feel something like a small pea under the skin to the top and upper, outer edge of one foot and had to loosen laces for relief. Happily now a thing of the past. You could be walking along, in the city and then suddenly WHAM!
Fortuitously, it was diagnosed ("possible...") by Joseph, a Qld doctor while at Shelf Camp. "Gout loves the joints" he taught me.
Age related? Likely so I suppose. Bushwalker prone? We do spend a lot of time semi dehydrated. Do Australians enjoy a drink ortwo? Does a wombat *&%$#! inthe woods? Thankyou Joseph. Some of the nicest people you meet off piste.