Joe A Shaw PA-C - 2/14/2008

Question
My husband fell and injured his left foot-ankle about 2 years ago he went to the doctor's, she gave him a coritsone injection the shot gave him some relief for a little while she also fit him for inserts for his shoes which caused him more pain.It's 2 years later and he's still having problems and pain he has burning and tingling in the bottom of his foot the tingling is constant and he has a steady pain in the middle of the bottom of the foot,the burning comes when he walks on it ( about the length of a supermarket) the more he walks the more it burns he has pain on the left side of his ankle that radiates along the left side of his foot he has discoloration on the left side of his ankle (looks like it's bruised) when he has to walk for a long time he said it feels like his toe's are being pulled up. The MRI report said 1st MTP minimal osteoarthritis with distal 1st metatarsal head cyst it also said there is an artifact which may be from a prior surgery, he hasn't had any surgery.Could you please give me your opinion of what might be wrong with his foot I would greatly appreicate any help. My husband is 58 years old. Thank You

Answer
Cheryl,
He may have RSD (reflex sympathetic dystrophy) or the newer term is complex regional pain syndrome. This is a diagnosis of exclusion...in other words once and orthopedic foot/ankle specialists has ruled out (or exculded) fractures, ligament tears etc..they may give him this diagnosis. It is a little understood condition and should be treated by a specialists who sees this kind of thing on a regular basis. Often the orthopedists will have a pain specialists that they refer pts like these to.(These may be neurologists, or physiatrists-[Fizz-i-a-trist]).
He also should be evaluated for tarsal tunnel syndrome...kind of like carpal tunnel syndrome of the foot. Sometimes ankle injuries can cause nerve damage and this can give you numbness,aching etc in the foot and toes.
He should also be checked for diabetes and vascular (circulation problems) in the foot and ankle and elsewhere, again the arteries and veins can be injured during these type of things and this could cause them not to flow as well as they once did.
So I would seek out an orthopedist who specializes in feet and ankle problems first then he can refer your husband if needed.