Frustrated by Foot Pain

I have been having foot pain since the beginning of the year. *sigh*

So my GP tells me to go see my Rhuemy, who gave me a cortizone injection in my foot (OUCH!) and told me if that didn't help to go have a bone scan. I had the scan last week and the results are to me, unusual. The pics look really cool though. Maybe I'll post them up!

There is no degenerative damage in the left foot where I have the most pain, however... In my right foot, which hurts, but not as my as my left there is degenerative damage to the joints.

How wierd is that! Also frustrating as heck, as it does not solve the main pain. This pain is so bad that I had a migraine on tuesday night and the pain in my foot was competing for with the pain in my foot, which says a lot.

Upshot is I am off for ANOTHER cortizone injection on Wednesday, I will have an anisthetic (sp?) this time! I have to wait until March before I can see a podiatrist.

I thought having bad knees was frustrating. It is nothing compared to what I am feeling at the moment!

Thanks for reading my whine!

Hi Louise, my PsA firstly started acutely in my foot, specifically around the ball of the foot in line with the second toe (The MTJP) which was excruciating to walk on. I saw a podiatrist who suspected ruptured plantar plate, had ultrasound all ok. Then he suspected stress fracture, had xray all ok.

Anyway a MRI scan was ordered and florid tenosynovitis was found, ie the tendon sheath was highly inflamed. This is common with PsA and would not show up on an xray.

I had a cortizone shot and it helped for 2 days before inflammation returned!

The only thing that has helped me with that is wearing good padded running shoes most of the time and anti-inflams. A podiatrist may be able to help with fitting orthotics to help take load of certain trouble making joints.

I would definitely ask your doctor about MRI scans to aid in diagnosis.

Hi, My PsA also started acutely in my feet. I was put on methotrexate and presidone to be able to walk and have the inflammation go down so I could put any shoes on. This was about 7 wks ago, I am still awaiting my first appointment with a rhemy in March. I am now able to walk but very slowly and like an old granny.(no offence to grannies but I am only 38yo). I am unsure whether a podiatrist or physio are the way to go. I can feel the scar tissue or deterioration occurring daily. I would love to hear how you get on with the podiatrist and if you try anything else that works. I have a pool at home and getting in and just kicking in an upright position hurts but helps immensely after I get out. Good luck I hope your feet feel better soon - it is certainly a bugger to have sore feet.

My poor Louise, I'm confused about which foot got cortisone and how long ago and how that foot is feeling now. Forgive my stupidity. But I'll err on the side of caution and ask: DID YOUR RHEUMATOLOGIST HAVE THE WITS TO TELL YOU that while you're likely to experience immediate relief from a cortisone injection, that it's extremely common to have a CORTISONE FLARE shortly afterward that is often more painful than the pain you had before? Sorry to yell, but I want to be sure you know that. I think you probably know this, but in case you don't, it's normal, actually means the cortisone is working and the pain will go away very soon. Cortisone flares usually occur 24-48 hours after an injection. (I don't know why this is in italics, or how to make the print normal, and I certainly don't know why you should pay attention to anything that a person who can't even handle a computer says. Sorry, Louise!) A cortisone flare doesn't last more than a day or two.

If you Google "cortisone flare" you'll find many sites that will give you better information than I can. I find ice helps a cortisone flare a lot.

Often after a cortisone injection, there's local pain from the injection itself - it hurts to have a needle stuck into you and your body protests. But over the first couple of days after a cortisone injection, some of the cortisone crystallizes in the joint, so you've got some sharp little jabbers that are making your joint generally unhappy. They will dissolve in a couple of days and your joint is likely to feel very much better than it did before the cortisone injection. It's actually good news, because it means that your rheumatologist actually injected the cortisone into the joint, and didn't miss it. (Sometimes they do miss it - not to shake anyone's faith in doctors.) Did your rheumatologist also tell you that a little of the cortisone leaks out of the joint and finds its ways into other joints and tissues and has a generally beneficial effect on them, too? So people might expect some general relief after a cortisone injection in a joint.

Your comparison with the pain of a migraine says a lot. I'm finding that it's very hard to get people to understand how intense the pain can get.

And my goodness, yes, your podiatrist should absolutely start injecting a numbing agent as soon as the needle penetrates your skin. I'm not a podiatrist, but my orthopedist uses the same needle for both the anesthetic and the cortisone, so it doesn't take two injections. She just injects the anesthetic, leaves the syringe in, and after the anesthetic starts working - which for me is quickly - she just changes the barrel - the pump - the tube that has the medication in it. She has it right there and ready. She's a tough old bird from the days when women had to fight to get into medical school, and she knows what she's doing.

Again, I am not qualified to give medical advice, but of the "caine" medications - like novocaine - that numb tissue, the one that lasts longest - up to sixteen hours or so - is marcaine. When I have surgery, or more than ordinary dental work, I ask for that, because a lot of pain from a surgery or complex dental work has settled down after sixteen hours. I don't know if it's the best choice in a rheumatoid disorder.

Also, Louise, I'm afraid that because I'm not sure which foot you're having more cortisone in on Wednesday, I hope that at least one of your doctors has talked with you about how many injections of cortisone it's okay to have in one joint during a specific period of time without any injury to the joint? This is more complicated in rheumatoid disorders, and I don't know the answers, but I would sure ask the question.

Please forgive me, Louise, if my comments have been intrusive, incorrect or in any way out-of-line. Like you, I think images of how our bodies look inside are cool, and I have a couple of copies of my chest x-rays that I think are nifty. Is my rib cage really that small? I can't believe I actually fit into it. My vertebrae look about the size of the ones you find in a can of salmon.

My right foot is my most painful area, and the first symptom to lead anyone to think about PsA.

Thank you for the thoughts on MRI, DaveAus. Very helpful! I had an MRI last October, but the doctors were looking for signs of a bone infection and maybe missed what they weren't looking for. I have my first rheumatologist appointment Feb 10, so you've prompted me to do whatever amount of paperwork it takes to make the CD of the MRI available to her. She's the person who should know what to look for. I wouldn't have thought of that on my own, so many thanks.

As an old granny, I certainly take no offense to your description of walking, Margmotherof4. I'm sure you want so much to be able to wear your shoes all the time and to run around in them doing what you want to do. At 58, I still don't feel that old, and just this morning I was crying because I can't run around and play with my grandchildren as I could a year ago, and as I thought I would continue to do. Our five-year-old grandson is visiting in 42 days (I'm so eager to see him that I tick off the days) and it hurts that I can't take him to the playground or on walks as I used to. Thank goodness my husband, at 65, has "the body of a teenager" as his doctor says, and was able to teach our grandson to ride the little bike we got him, and take him out to ride every day on our last two-week visit. So that's fortunate. I hate being afraid to carry our one-year-in-one week granddaughter around because I feel, and am, so unstable on my feet. But she's just learning to walk, so pretty soon she won't need to be carried. In the meantime, I can hold her on my lap.

I haven't been able to wear shoes since last October, so I'm looking forward to an appointment with an orthotist who can build me shoes with a toe box that allows for the swelling that just doesn't go away. I'm very tired of going around town in slippers and oversized garden clogs.

Just putting my 2 cents in here. Yes, a Podiatrist is the person to see when you are having issues with the foot and/or ankle. Yes, most docs use numbing medication in the injections with the cortisone (usually lidocaine or marcaine) along with dexamethasone and kenalog. It is totally normal to bruise at the injection site and/or have pain worsen over the next 24 to 48 hours. Also, the running type shoes (Asics etc.) but you may also need to put an orthotic in the shoe. Supporting the arch/heel and metatarsals are essential with the type of pain we usually have with the PsA. The ones I wear are the Spenco Earthbound (they have a website). You have to remove the liner that comes in the shoes. Some are glued in just remove carefully. A great way to ice the bottom of the foot is to freeze a water bottle; place it under the foot while wearing a sock and roll front to back and over again for 15 mins. then just put the bottle back in the freezer. Do this 3 to 4 times a day. MRIs are great diagnostic tools because they will shoe tissue problems as well as fractures such as stress fractures that are within the bone and won't show on an x-ray till probably a good 3 weeks into the fracture. Cortisone injections will hinder the healing of a fracture, so is a good idea to have the MRI before any injections. As for the toe box needing to be larger to accomodate swelling...check out the shoes made for diabetics. They are required to be deeper and wider in the toe box and some have lycra that stretches.
This information comes from personal experience and working for a podiatrist for 5 years. Hope it helps.

Hi Everyone,

Thanks for your replies. :)

Just to clear things up just a little, the worst pain I am having at the moment is in my left foot, just under my little toe. Mostly in the webspace between the two toes. I has the cortizone injection there and it did help for about 2 weeks after the injection it was ok, then the pain started to get worse again. I have had cortizone injections before in other places for other things, I know how it hurts for a few days after then everything calms down and is good.

I have had an ultrasound, an x-ray, an MRI and finally the bone scan which included a CT scan of the area. The most anyone can tell me is that I have bursitis (swelling of the joint cusion) in my foot and that was diagnosed from the ultrasound. For the bone scan (not to be confused with a bone density scan) I was injected with a radioactive isotope, then scanned three hours later, after my bones had absorbed the radiation. I was really worried about that actually. But I wanted to be sure that the pain I am feeling was not caused by damage to my joint or any of the bones in my foot, and that a second injection would be worth the pain of it.

Honestly the pain does feel like a broken bone, but all of the scans are coming back negative for fractures.

So I await the injection on Wednesday - oh and my GP wants me to have a bone density scan as well, so that is scheduled for the same day. I also await my appt with the Podiatrist in March, hopefully they have some ideas that will help.

All I can say is thank the Gods that I live in Australia and I do not have to pay for all these scans and injections! As flawed as Medicare is, it definetly help those of us that need it!

Again thanks for all your suggestions and ideas!

So interesting to hear that so many of you started to feel pain first in your toes. My road to diagnosis also started in my left second toe. Went to an orthopedic doc b/c I thought I broke my toe. I described it as looking like a little sausage....turns out the diagnosis was sausage toe! LOL I got a cortisone injection that hurt really bad for a few days and ultimately had no effect. I walkind in a boot for a while in order to take pressure off the joint, but that didn't help either. Prednisone wasn't a remedy either. A year later I still have problems with my toes on the left and now on the right toes as well. I'm back on Humira and starting to see a difference.

Alma, thanks for the idea about shoes for diabetics that are deeper and have a wider toe box.

MMG, boy, I wish there were a more dignified common name for "dactylitis" than "sausage toe."

However, I wish that more medical professionals were clued into what a - for lack of a better - finger or toe that has taken on a sausage shape. That would save a lot of people a lot of pain and frustration searching for a diagnosis since it usually points to a rheumatoid disorder.

Talking about the "sausage toes/fingers"...of course mine never look like that when I have my rheumy appt. He told me to take a picture of it next time to be sure it is really swollen. Now, I am 54 y/o and think I know swollen and not. I agree with the undignified names used for some things.

Sooooo, i had the 2nd cortisone injection today in my foot.
Just to give you an idea of my pain thresh hold, I have given birth twice with no drugs, I have 3 tattoos, all of them obtained while I was sober. I also suffer the daily aches and pains of PsA and have done for most of my adult life. Just so you know…
I had half of the injection & that all that I could take! I screamed at the dr to stop and she did. I cried. I never cry.
Never again will I ever let anybody near my foot with a needle.
I am currently on the couch, with my hubby cooking dinner. Life is not all bad, just the parts with needles…

Oh boy do I feel your pain! I am having a wonderful year so far with my PsA symptoms....I started Huimira on Jan 9th and had a cortisone shot the same day and since that day I feel wonderful (not normal just so much better than i was) however my feet still hurt so badly that i still can hardly walk, and i thought it was my knee pain that was causing my walking issues! not sure what I am able to do about it but i am lucky enough to be getting some money back from my taxes and i plan on going to get a special shoe insert from one of those pain free shoe stores i have heard many people say that they are a god send so i will try and keep everyone posted