LL, I am totally impressed with your pt. Without getting into the whole long story, after years of being undiagnosed, developing foot problems (pain, and neuropathy), I was finally diagnosed with PsA when they found erosions in my feet. At that point, I went to a neurologist, who explained my neuropathy-like symptoms exactly the way your pt did. It was swelling in my mid feet pressing on the nerves. (There was no problem with the nerves themselves.) By the time they realized that my disease was severe and they found the right treatment for me, my feet were irreparably damaged. My damage is all mid-foot, although most people with PsA tend to have toe problems first. The longer story is here:
http://discussion.livingwithpsoriaticarthritis.org/profiles/blogs/listen-up-take-notes
I don’t know if your mid-foot problems are PsA related, but I sure would be asking my rheumatologist to do an investigation to see whether you have inflammation in those joints of your mid-foot. An x-ray will only show damage that is already done, but an MRI will show inflammation. I believe there are certain kinds of ultrasound which will also show inflammation.
The last time I saw my rheumatologist, I witnessed a teaching moment with a student. He impressed on the student that foot issues should never be taken lightly, and should always be thoroughly investigated. “Otherwise,” he said, “you can get this.” And he pointed at my foot x-rays and shook his head.
The last time I saw my foot surgeon, we discussed reconstructive surgery, which in my case would be extremely difficult because there are ten joint surfaces with severe damag in each midfoot. Given the risks and the uncertainty that I’d be better after the surgery than before, I’ve decided to leave well enough alone, and live with the pain and disability. I commented to him about how unusual my case is, that my toes and ankles are perfectly fine. His comment was that it’s not at all unusual for a disease like PsA to do damage such as what I have.
Knowing what I know now (and living with what I have) I wish that I had been more insistent that my foot issues be thoroughly investigated, particularly after I was diagnosed with PsA. I was too trusting of the professionals who seemed to think that new orthotics were the answer, and another who saw no urgency despite the fact that I already had midfoot damage. Hindsight is wonderful, isn’t it?
Many joints in the body can be successfully replaced and repaired. But foot damage is very difficult to set right once it has happened. For what it’s worth, I’d suggest having your feet thoroughly investigated, and also accepting the most aggressive therapy that your rheumatologist is prepared to give you. Feet are that important.