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Foot & Ankle Problems Message Board


Foot & Ankle Problems Board Index


Hello,

I have been injured for over five months now with no end in sight and my entire life is in shambles as a result. I literally cannot do anything. I cannot work and have gone on disability, I cannot walk without crutches, and being someone who was 20 hours/week active prior to this injury, I am losing my mind to put it lightly. I am hoping someone here has some insight as to my bizarre impossible injury. I would be thankful for anything at all.

My apologies for the length of this, but I feel a full account of my situation is warranted to hope for the best advice. I have been a runner, cyclist, soccer player, and beach volleyball player for the entirety of my life. To give you some background I am 34, male, weigh 150, and am almost 6'2. I have had four knee surgeries on my right knee (ACL reconstruction, notchplasty, meniscus repair, meniscectomy). None of these are currently huge issues, but it is helpful to know.

To bring things up to current, I suffered for about 7 or 8 months last year starting in January 2015 with patellar tendinitis in my left knee from compensating for my weaker 4-surgery right leg. After finally overcoming that injury I had about two months of playing beach volleyball and running again, only to now have a plantar plate injury to the big toe of my left foot at the end of last year in November. Note that nothing in particular occurred and there was no warning sign whatsoever in my injury. One day I just couldn't walk properly on it and the base of my big toe (the plantar plate) is the center of the pain. Also note that for the past five months since my injury, anytime my foot is not elevated it swells up and gets red and sometimes even purple. The odd part is you can bend and stretch the toe any direction you want and it is fine. Strength is also totally fine. If I try to walk on it or even just stand on it then it is painful. Here is the chronology of my injury:

Nov 12: Injury date. Immediately put myself on crutches. Started following RICE (rest, ice, compression, elevation) religiously. Started taking NSAIDs. Ceased all forms of activity.

Nov 23: See my Primary Care Physician and get referred to Orthopedic Sports Medicine Doctor, who is a surgeon who specializes in feet here in Santa Monica.

Dec 3: X-Ray taken, nothing shown. Still on crutches.

Dec 15: My doctor (the orthopedic sports medicine one) puts me in a hard-bottom sandal and diagnosed me as having turf toe. I toss the crutches aside and go with the sandal full-time, which seems okay.

Jan 20: After over a month on the sandal I decide to get back on crutches out of sheer frustration due to the lack of forward progress.

Feb 23: Begin Physical Therapy. We meet twice a week for 45 minutes and do ultrasound, laser, and then electrical stim with ice. We have 10 sessions total which end Apr 8 after giving up PT as being helpful.

Feb 27: Tried dancer pad to protect the base of the toe. Did not work and made it worse. Tried carbon fiber orthodic. This just made it worse and was painful.

Mar 6: Foot seems to be doing better. I try walking around on it with strong-soled running shoes for a couple of days. The "doing better" doesn't stick.

Mar 9: Visited a rheumatologist to make sure I didn't have any circulation issues or gout. Tested for gout, came back negative. She did not think I had any specific circulation issues.

Mar 11: MRI taken and the results show a 1cm tear according to radiologist. Exact words on the report are: There is a tear of the underlying plantar plate with the proximal 1cm of the structure absent. There is marrow edema in both hallux sesamoid bones. There are mild degenerative changes at the hallux MTP joint. No fracture, no abnormal joint fluid, no tenosynovitis. Impression: Hallux plantar plate tear. Oddly enough, my ortho doctor plus another (both are orthopedic sports medicine doctors who both specialize in feet) both agree they are not sure it is a definitive tear or not. I am diagnosed by my ortho doctor as having "acute plantar plate inflammation, and a plantar plate sprain." Of this I am positive, as I have the conversation recorded. When we discuss the MRI readings by the radiologist which clearly state I have a tear, she says this was not the case. She later spoke to the radiologist, and then the report was amended, with the addition being Addendum: Report should read "...the distal 1 cm of the structure absent." Also, this is a central, partial-thickness tear."

Mar 18: Second opinion for MRI results and she confers that the MRI is not definitive and it may be torn, it may not be torn. We discuss PRP as a possible course of action.

Mar 25: PRP injection performed. Note this cost me $1000 out of my pocket. Went on disability from work in order to devote 100% of my time to healing. Each day after this day my foot is elevated for 95% of my day and I am using crutches. No NSAIDs (they would counter the effects of the PRP), no ice. I am doing NOTHING all day. I have literally devoted my entire life to letting my foot heal.

Apr 8: Got CAM boot (the one with Velcro you can take off and on as needed) boot but it is still too painful to use as of yet.

Apr 18: Today is three and a half weeks after my PRP injection and I do not feel any better off than I was before I had it. The injection itself really inflamed my injury and the first few days it was extremely tender, so it has certainly healed from then, but I still cannot tell if it is any better than prior to the injection.

In conclusion, I am not sure where to turn. I have tried everything. I am hoping the PRP ends up doing the trick, but honestly every time I check my toe by applying some pressure to it I do not feel that the progress is really going that well. There is always a specific point where there is pain. I just cannot shake it. I am afraid I am going to lose my job because of my inability to walk (I work retail), not to mention the fact that my entire life is on pause and I cannot play sports. It is absolute torture.

Does anyone have any advice on this injury? Any experience with plantar plate injuries? Is surgery the only option? How long does PRP take to be determined as successful or not?

Thank you for your time if you managed to read my lengthy tale of woe.
[QUOTE="SM487;5413971"]Hello, I have been injured for over five months now with no end in sight and my entire life is in shambles as a result. I literally cannot do anything. I cannot work and have gone on disability, I cannot walk without crutches, and being someone who was 20 hours/week active prior to this injury, I am losing my mind to put it lightly. I am hoping someone here has some insight as to my bizarre impossible injury. I would be thankful for anything at all. My apologies for the length of this, but I feel a full account of my situation is warranted to hope for the best advice. I have been a runner, cyclist, soccer player, and beach volleyball player for the entirety of my life. To give you some background I am 34, male, weigh 150, and am almost 6'2. I have had four knee surgeries on my right knee (ACL reconstruction, notchplasty, meniscus repair, meniscectomy). None of these are currently huge issues, but it is helpful to know. To bring things up to current, I suffered for about 7 or 8 months last year starting in January 2015 with patellar tendinitis in my left knee from compensating for my weaker 4-surgery right leg. After finally overcoming that injury I had about two months of playing beach volleyball and running again, only to now have a plantar plate injury to the big toe of my left foot at the end of last year in November. Note that nothing in particular occurred and there was no warning sign whatsoever in my injury. One day I just couldn't walk properly on it and the base of my big toe (the plantar plate) is the center of the pain. Also note that for the past five months since my injury, anytime my foot is not elevated it swells up and gets red and sometimes even purple. The odd part is you can bend and stretch the toe any direction you want and it is fine. Strength is also totally fine. If I try to walk on it or even just stand on it then it is painful. Here is the chronology of my injury: Nov 12: Injury date. Immediately put myself on crutches. Started following RICE (rest, ice, compression, elevation) religiously. Started taking NSAIDs. Ceased all forms of activity. Nov 23: See my Primary Care Physician and get referred to Orthopedic Sports Medicine Doctor, who is a surgeon who specializes in feet here in Santa Monica. Dec 3: X-Ray taken, nothing shown. Still on crutches. Dec 15: My doctor (the orthopedic sports medicine one) puts me in a hard-bottom sandal and diagnosed me as having turf toe. I toss the crutches aside and go with the sandal full-time, which seems okay. Jan 20: After over a month on the sandal I decide to get back on crutches out of sheer frustration due to the lack of forward progress. Feb 23: Begin Physical Therapy. We meet twice a week for 45 minutes and do ultrasound, laser, and then electrical stim with ice. We have 10 sessions total which end Apr 8 after giving up PT as being helpful. Feb 27: Tried dancer pad to protect the base of the toe. Did not work and made it worse. Tried carbon fiber orthodic. This just made it worse and was painful. Mar 6: Foot seems to be doing better. I try walking around on it with strong-soled running shoes for a couple of days. The "doing better" doesn't stick. Mar 9: Visited a rheumatologist to make sure I didn't have any circulation issues or gout. Tested for gout, came back negative. She did not think I had any specific circulation issues. Mar 11: MRI taken and the results show a 1cm tear according to radiologist. Exact words on the report are: There is a tear of the underlying plantar plate with the proximal 1cm of the structure absent. There is marrow edema in both hallux sesamoid bones. There are mild degenerative changes at the hallux MTP joint. No fracture, no abnormal joint fluid, no tenosynovitis. Impression: Hallux plantar plate tear. Oddly enough, my ortho doctor plus another (both are orthopedic sports medicine doctors who both specialize in feet) both agree they are not sure it is a definitive tear or not. I am diagnosed by my ortho doctor as having "acute plantar plate inflammation, and a plantar plate sprain." Of this I am positive, as I have the conversation recorded. When we discuss the MRI readings by the radiologist which clearly state I have a tear, she says this was not the case. She later spoke to the radiologist, and then the report was amended, with the addition being Addendum: Report should read "...the distal 1 cm of the structure absent." Also, this is a central, partial-thickness tear." Mar 18: Second opinion for MRI results and she confers that the MRI is not definitive and it may be torn, it may not be torn. We discuss PRP as a possible course of action. Mar 25: PRP injection performed. Note this cost me $1000 out of my pocket. Went on disability from work in order to devote 100% of my time to healing. Each day after this day my foot is elevated for 95% of my day and I am using crutches. No NSAIDs (they would counter the effects of the PRP), no ice. I am doing NOTHING all day. I have literally devoted my entire life to letting my foot heal. Apr 8: Got CAM boot (the one with Velcro you can take off and on as needed) boot but it is still too painful to use as of yet. Apr 18: Today is three and a half weeks after my PRP injection and I do not feel any better off than I was before I had it. The injection itself really inflamed my injury and the first few days it was extremely tender, so it has certainly healed from then, but I still cannot tell if it is any better than prior to the injection. In conclusion, I am not sure where to turn. I have tried everything. I am hoping the PRP ends up doing the trick, but honestly every time I check my toe by applying some pressure to it I do not feel that the progress is really going that well. There is always a specific point where there is pain. I just cannot shake it. I am afraid I am going to lose my job because of my inability to walk (I work retail), not to mention the fact that my entire life is on pause and I cannot play sports. It is absolute torture. Does anyone have any advice on this injury? Any experience with plantar plate injuries? Is surgery the only option? How long does PRP take to be determined as successful or not? Thank you for your time if you managed to read my lengthy tale of woe.[/QUOTE]

Hi SM487- First, I am sorry you are dealing with this and that it has been so long. I don't have experience with this injury, but I have been through the ringer with my foot over the last year. I just wanted to share my reflex thoughts after reading your post...

If you have your foot elevated and are not using the muscles in your lower leg after all this time, the perfusion when your foot is in a dependent position is going to be abnormal. Hence the red, purple, and swelling. That just takes getting it back down and tolerating and getting the muscles working to pump the blood.

Have you sought out a second opinion from a different doctor in a different practice? I'm in LA also and cedars has 3 exceptional foot and ankle surgeons. Take your MRI on a disc and take the report, don't take clinic notes and don't tell them what the other doctors said. Let them form their own opinion.

Why hasn't anyone consider your sesamoid bones as a source the pain? If there is edema, that is the equivalent of a stress reaction or stress fracture. I know people that had pain with those for years and had to have them removed or never had relief until the bones "died". They couldn't walk or put pressure. I would think if there was a tear your would def have pain when that area is under stress even with passive motion. Like when they move it all around in PT.

PRP can take for ever to show results!! I have had injections in my knee and in an important tendon in my foot and i had inflammation initially but then the same pain returned and it took months before I realized I was able to do more things than I could before the injury. It was so long, I had already given up. If you are doing prp you should consider a true regenerative medicine orthhopedic practice. There is a prominent one in LA.

Only other thing I can think of is CRP, but since you tolerate all the modalities at PT I don't think that is what's happening either.

Hope something here switches a light bulb or that some of it is helpful.





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