foot problem/mri report no, docs dont know what to do??

metronycguy · 02-20-2004, 11:03 AM

I have had foot pain when weighting foot or trying to walk since October 2003 ,I landed hard on the materials area of my foot lowering myself off the back of a truck. since than I have had incredible pain weighting my foot and trying to walk, basically been off it since early November.
I was using crutches and cane in November and December. they though I had a stress fracture, but it never healed.
now able to walk maybe 100 feet before pain becomes rough. nerve pain, radiates towards toes
my injury and surgery were at l4/l5 l5/S1 . it caused cauda equina and foot drop ,ankle weakness, toes don't move, hang down. plenty of neuropathic pain in same injured foot. but the neuropathic pain is different than this pain.

I was able to limp on this foot for about 2 years, no push off as my calf muscles don't work. foot always felt numb and frostbitten, but I was able to hike and snowshoe with a brace, actually was better snowshoeing than walking since Frankenstein step of snowshoes, didn't require calf or toes push off. I even was able to snowshoe up mountains that took 10 hours with no foot pain problems,

it is much better now than it was 3 months ago, but I still cant go 100 feet without nerve pain, in november I couldn't go 5 feet , swimming breaststroke frog kick I can feel the nerve pain , freestyle kick hurts immediately and is too painful,
finally had the MRI and results are below, my orthopedist who has been around for probably 30 plus years, told me he has no ideas on how to fix it , its out of his realm, he is sending me for a Doppler next.
I just called my physiatrist, he says its out of his expertise looking at the MRI report.
I made an appointment to see a podiatrist I trust that did surgery on my other foot years ago. see him on Monday
my pain management wanted to install a spine stim in me ,since everybody assumed it was increased neuropain in october, before I realized my neuropain never increases while I was walking on it, only a couple hours latter or in the evening or when sleeping.
I have taken neurontin, zonegran topomax, and I was taking topomax when this happened.
I cant seem to find someone to look at the big picture, the physiatrist doesn't believe the back injury has anything to do with it,
but I know with the weakened calf muscles, foot being red a lot due to inability of blood to pump back up and pooling , and medications for neuropian, it may add to the healing or lack of healing? or still a pseudo gout from topomax, which they still discount, but still nags at me..
what type of doctor should I be seeing for this,? my physiatrist and orthopedist cant recommend any?
hopefully the podiatrist will be able to figure something out,
my acupuncturist is the only so far to really touch my foot and try to figure out what is causing it, when the toes and joints are moved I get incredible, screaming pain,
I wouldn't bet the farm that the tendons are not detached or at least ripped since I had instantaneous pain when i fell on it..

MRI report follows

,

history.. Rule out stress fracture

MRI of the foot was performed utilizing sagittal and short axis TI and STIR images, TI and T2
weighted images parallel to the long axis of the foot.
There is extensive edema 'within the soft tissues of the foot enveloping the second and third
metatarsals, and within and between the muscles at the sole of the foot. No discrete mass or fluid
collection is seen, No abnormal signal is seen within the bone marrow. A stress fracture and
osteomyelitis are effectively ruled cut in the absence of marrow edema. The diffuse soft tissue
swelling suggests an injury or inflammatory process. No fracture or dislocation is seen. The
flexor tendons at the base of the foot are enveloped by edema, but do not appear to be
interrupted.

lMPRESSION: there is no evidence of stress fracture, There is diffuse edema enveloping the
deep structures at the volar aspects of the mid foot and extending between and around the second and third metatarsals. no mass or collection is seen

SCI-Nurse · 02-20-2004, 12:28 PM

I think the podiatrist is the right direction.
How about plantar fasciitis as a diagnosis? The pain is different, you don't seem to have it when the foot is flat and you aren't pushing off, your toes hang down due to your injury, the pain is there when you bring your toes up. Check it out with the podiatrist.

JM

metronycguy · 02-20-2004, 12:56 PM

pain seems to be mainly in the forefoot, i basically have to only weight the heel now.
i wish they could have seen the insertion point of the flexor tendons, that is where my original pain ,when i landed on it with my foot drop 4 months ago,
i detachahed my bicep tendon about 4 months after my spine surgery ,
i always wondered if the medications dry out my tendons?
and why so much edema this long after injury

02-20-2004, 11:03 AM	#1
metronycguy Senior Member Join Date: Dec 2002 Location: ny Posts: 5,674	foot problem/mri report no, docs dont know what to do?? I have had foot pain when weighting foot or trying to walk since October 2003 ,I landed hard on the materials area of my foot lowering myself off the back of a truck. since than I have had incredible pain weighting my foot and trying to walk, basically been off it since early November. I was using crutches and cane in November and December. they though I had a stress fracture, but it never healed. now able to walk maybe 100 feet before pain becomes rough. nerve pain, radiates towards toes my injury and surgery were at l4/l5 l5/S1 . it caused cauda equina and foot drop ,ankle weakness, toes don't move, hang down. plenty of neuropathic pain in same injured foot. but the neuropathic pain is different than this pain. I was able to limp on this foot for about 2 years, no push off as my calf muscles don't work. foot always felt numb and frostbitten, but I was able to hike and snowshoe with a brace, actually was better snowshoeing than walking since Frankenstein step of snowshoes, didn't require calf or toes push off. I even was able to snowshoe up mountains that took 10 hours with no foot pain problems, it is much better now than it was 3 months ago, but I still cant go 100 feet without nerve pain, in november I couldn't go 5 feet , swimming breaststroke frog kick I can feel the nerve pain , freestyle kick hurts immediately and is too painful, finally had the MRI and results are below, my orthopedist who has been around for probably 30 plus years, told me he has no ideas on how to fix it , its out of his realm, he is sending me for a Doppler next. I just called my physiatrist, he says its out of his expertise looking at the MRI report. I made an appointment to see a podiatrist I trust that did surgery on my other foot years ago. see him on Monday my pain management wanted to install a spine stim in me ,since everybody assumed it was increased neuropain in october, before I realized my neuropain never increases while I was walking on it, only a couple hours latter or in the evening or when sleeping. I have taken neurontin, zonegran topomax, and I was taking topomax when this happened. I cant seem to find someone to look at the big picture, the physiatrist doesn't believe the back injury has anything to do with it, but I know with the weakened calf muscles, foot being red a lot due to inability of blood to pump back up and pooling , and medications for neuropian, it may add to the healing or lack of healing? or still a pseudo gout from topomax, which they still discount, but still nags at me.. what type of doctor should I be seeing for this,? my physiatrist and orthopedist cant recommend any? hopefully the podiatrist will be able to figure something out, my acupuncturist is the only so far to really touch my foot and try to figure out what is causing it, when the toes and joints are moved I get incredible, screaming pain, I wouldn't bet the farm that the tendons are not detached or at least ripped since I had instantaneous pain when i fell on it.. MRI report follows , history.. Rule out stress fracture MRI of the foot was performed utilizing sagittal and short axis TI and STIR images, TI and T2 weighted images parallel to the long axis of the foot. There is extensive edema 'within the soft tissues of the foot enveloping the second and third metatarsals, and within and between the muscles at the sole of the foot. No discrete mass or fluid collection is seen, No abnormal signal is seen within the bone marrow. A stress fracture and osteomyelitis are effectively ruled cut in the absence of marrow edema. The diffuse soft tissue swelling suggests an injury or inflammatory process. No fracture or dislocation is seen. The flexor tendons at the base of the foot are enveloped by edema, but do not appear to be interrupted. lMPRESSION: there is no evidence of stress fracture, There is diffuse edema enveloping the deep structures at the volar aspects of the mid foot and extending between and around the second and third metatarsals. no mass or collection is seen

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02-20-2004, 12:28 PM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,331	I think the podiatrist is the right direction. How about plantar fasciitis as a diagnosis? The pain is different, you don't seem to have it when the foot is flat and you aren't pushing off, your toes hang down due to your injury, the pain is there when you bring your toes up. Check it out with the podiatrist. JM

02-20-2004, 12:56 PM	#3
metronycguy Senior Member Join Date: Dec 2002 Location: ny Posts: 5,674	pain seems to be mainly in the forefoot, i basically have to only weight the heel now. i wish they could have seen the insertion point of the flexor tendons, that is where my original pain ,when i landed on it with my foot drop 4 months ago, i detachahed my bicep tendon about 4 months after my spine surgery , i always wondered if the medications dry out my tendons? and why so much edema this long after injury