Dr. Runco please help!
After 5 doctors and 3 physical “terrorists” I finally had an MRI which shows severe 2nd toe joint capsulitis and bone marrow edema in the metatarsal head with “no fracture line identified.”
The last podiatrist had me take off my shoes and watched me walk barefoot down his hall. After 30 seconds he said I needed $900 dollar shoe inserts and might need surgery. I did not trust him so I split. I am willing to drive down from LA to see you….your videos on the subject explained far more than any of the “specialists” I have seen here.
Thank you for your email and I am sorry about your foot. Good thing you got out of there and away from the “Podiaterrorist”. There is no way he could see anything of value while watching you walk on a painful foot for 30 seconds. Plus, $900 for orthotics is pretty steep considering we charge $367 or $500 for 2 pair! I doubt at this stage of your injury orthotics are appropriate anyway. After I examine your foot I will know the extent of your injury and be able to provide you with an exact treatment plan and timeline to heal and avoid surgery. In the meantime let me explain the physiology of what is going on.
Capsulitis of the 2nd and 3rd metatarsal-phalangeal joints (MTP’s) is common (and painful). The joint capsule is part of the ligament structure along with the plantar plate ligament that connects your toes to your foot and provides stability. Within the joint capsule is synovial fluid (like motor oil in a car) that bathes the cartilage and nourishes it. If the plantar plate ligament and/or joint capsule is repetitively over-stretched it can result in tearing and then inflammation, hence the term “itis”. Inflammation is your bodies normal reaction to tearing and is the first stage of the healing process.
Many patients suffering from capsulitis are mismanaged by doctors and therapists from the beginning. They tell the patient to suppress the inflammation with Ibuprofen, Motrin, Alleve etc and ice. Some even inject the damaged ligament with cortisone which is a powerful anti-inflammatory. Unfortunately it also results in destruction of a portion of the joint capsule setting the patient up for future problems. All of this inhibits your body’s natural healing response and slows or even stops healing. You body wants to send cells called platelets to patch the tear but by inhibiting the inflammation you are inhibiting the platelets from doing their job.
If the inflammation were allowed to proceed and the area protected from aggravation the next stage would be the Repair Stage. During this stage your body mobilizes cells called Fibroblasts which are like a construction team. They secrete new tissue and essentially patch up the damaged area. This can take from 2 weeks to 3 months depending on the extent of the damage. Often patients do things to cause continuing aggravation which results in the joint capsule either not healing or healing poorly with excessive scar tissue.
Once the repair stage is complete and the patches are made your body will enter the third stage known as the Remodeling Stage. You body bring cells to the area to reshape and remodel the new tissue so that you are good as new. Normal activity can be resumed during this stage usually without concern for aggravation.
While you are setting up your appointment I want you to go shoe shopping. The below shoes are built on “Metatarsal Rocker” technology and will take some of the pressure and pain off your foot. If necessary we can always have you wear a protective boot but these will suffice in the meantime. I also gave you a sandal company that is thickly cushioned and take some strain off the metatarsal area. Please bring your MRI with you to the appointment and the shoes you chose as most comfortable. At your appointment we will perform a thorough exam, review your MRI and then go over any and all treatment options to maximize your recovery. Please take a picture of the front and back of your insurance card and email it to Drallen@sdri.net so we can verify your benefits prior to your appointment. Please fill out my online new patient forms NewPatientForm and call 858-268-8525 to schedule your appointment. I look forward to helping you as I have hundreds of others with similar injuries.
Terox Sandal RockerSandal