Dr. Runco please help!
I had an MRI which shows mild 2nd toe flexor tenosynovitis and “no fracture line identified.”
The podiatrist said I have a stress fracture. Your helpful video said the treatment is the same though, so that is comforting. A boot to the knee was ordered. Anything else I can do to help it heal? My husband and I were walking every morning, fast, and barefoot 2.5 miles on the beach. We have not done so in several months when the pain began (August).
Thank you for your email and I am sorry about your foot. Flexor tenosynovitis is a condition that can affect the metatarsal region but it is also a condition that is over diagnosed when the patient actually has a slight tear in their plantar plate ligament or collateral ligament.
Because you have had an MRI we will ASSUME the in your case the diagnosis is accurate although after years of questioning MRI’s results and radiology reports I have come to find out that MRI technology is open to interpretation and not all radiologist are competent.
You mentioned that i had said that the treatment for stress fractures and tenosynovitis were the same…..that is not 100% accurate or at least I did not mean to convey that. What I meant was that if a patient agrees to wear a boot for 6 weeks either condition will USUALLY get better. That being said I would rather someone have a stress fracture than tendon injury as bone heals fast, easy and well whereas tendons and ligament do not due to their limited blood supply. Because of the limited blood supply we encourage therapies that increase circulation such as heat, ultrasound and active muscle/tendon contraction (without pain) and discourage therapies that decrease circulation such as ice or trigger point therapy.
A boot to the knee seems overly aggressive and not practical nor comfortable. I can recommend a few brands of rocker bottom shoes that might work very well for your injury. The purpose of the boot is to restrict movement of your flexor tendon and prevent you from making the condition worse. In that case rocker bottom shoes can often accomplish the same goal. Try:
Mary I hope your foot heals quickly. If when the boot comes off (or my rocker bottom suggestion) and the pain is persisting it is possible you have a more serious injury and if you would like my help and guidance simply choose from the options below.
- New patient exam at our Sports injury clinic in Kearny Mesa, San Diego. You can call to schedule an appointment at 858-268-8525. The cost is $167 for the exam and then $69 for any necessary treatment(s) the cost of which may be covered in part or in entirety by insurance.
- A home based therapy program. This includes a list of any necessary home therapy products you will need for rehab plus a video tutorial of me showing you step-by-step instruction of the rehabilitative stretches, strengthening exercises, massage tools, the do’s-and-dont’s of returning to physical activity and a follow up email where you can ask any follow up questions regarding your case. The cost for this is $69.
- A phone consultation. You send me the copy of your MRI report and a chronological history of your condition, the treatments tried and any other necessary information relevant to your condition. After our phone consultation I will send you a written treatment plan with specific instructions so that you may go to a doctor or therapist of your choice to implement it. The cost for this is $167. This is not covered my insurance and you can schedule it by calling 858-268-8525.