NT Doctors/Cartilage Injury Sufferers, I Need Your Opinions

[AgentZero]

About three months ago after playing basketball, I experienced some pain when walking in my first metatarsal (where your big toe connects to your foot). I assume I must have injured it while playing and decided to take about a month off from hooping.

Ever since the injury I've been favoring it some and walking more on the outside of my foot, which has put some stress of my leg, specifically the calf/Achilles area. When I started playing again, I was able to play for about two months till I decided to play it safe due to leg soreness/the injury.

The x-rays didn't reveal any bone damage, but the MRI I recently had revealed cartilage fissuring along the first metatarsal head, tiny subcortical cysts, sclerosis and marrow edema, and a small joint effusion. The doctor also mentioned inflammation.

My doctor gave me a Morton's toe insole (essentially a thin carbon fiber plate for your shoe that runs from the heel to only your big toe) to support it while walking and to limit the amount it can bend. I've only had it for a few days. They also recommended a cortisone injection and, worst case, surgery if the insole and injection didn't help much.

I'm going to give try out the insole for another week and start to stretch out my leg because I'm starting to think a good amount of the pain is coming from soreness and not all from the toe. Based on how it's feeling I'll probably try the cortisone injection.

I figured I'd reach out to NT to see what you guys thought because my doctor hasn't been much help. Any opinions or experience with similar injuries would be helpful.

Cliffs:

• ​Injured my foot playing ball 3 months ago
• MRI showed inflammation and cartilage damage on joint where big toe connects to foot
• Recently given a Morton's toe shoe insole for support
• Doctor suggested cortisone injection and if insole/injection ineffective, worst case surgery
• Currently trying to figure out the best treatment route to take

I've heard that cortisone injections can potentially do long-term damage to cartilage while providing a few months worth of relief, but would only one be okay? Also, if inflammation is a problem, shouldn't I just immobilize my foot with a walking boot or crutches for a while so that it dies down? Or is that unnecessary?

 

[HEATHEN]

About three months ago after playing basketball, I experienced some pain when walking in my first metatarsal (where your big toe connects to your foot). I assume I must have injured it while playing and decided to take about a month off from hooping.

Ever since the injury I've been favoring it some and walking more on the outside of my foot, which has put some stress of my leg, specifically the calf/Achilles area. When I started playing again, I was able to play for about two months till I decided to play it safe due to leg soreness/the injury.

The x-rays didn't reveal any bone damage, but the MRI I recently had revealed cartilage fissuring along the first metatarsal head, tiny subcortical cysts, sclerosis and marrow edema, and a small joint effusion. The doctor also mentioned inflammation.

My doctor gave me a Morton's toe insole (essentially a thin carbon fiber plate for your shoe that runs from the heel to only your big toe) to support it while walking and to limit the amount it can bend. I've only had it for a few days. They also recommended a cortisone injection and, worst case, surgery if the insole and injection didn't help much.

I'm going to give try out the insole for another week and start to stretch out my leg because I'm starting to think a good amount of the pain is coming from soreness and not all from the toe. Based on how it's feeling I'll probably try the cortisone injection.

I figured I'd reach out to NT to see what you guys thought because my doctor hasn't been much help. Any opinions or experience with similar injuries would be helpful.


Cliffs:

• ​Injured my foot playing ball 3 months ago
• MRI showed inflammation and cartilage damage on joint where big toe connects to foot
• Recently given a Morton's toe shoe insole for support
• Doctor suggested cortisone injection and if insole/injection ineffective, worst case surgery
• Currently trying to figure out the best treatment route to take

I've heard that cortisone injections can potentially do long-term damage to cartilage while providing a few months worth of relief, but would only one be okay? Also, if inflammation is a problem, shouldn't I just immobilize my foot with a walking boot or crutches for a while so that it dies down? Or is that unnecessary?

I'm no doc but with cortisone shots, as long as you take it easy and gradually ramp up activity over time you should be good.

A lot of dudes get the shot and feel good so they rush things and end up putting far too much stress on their feet.

Get that shot and take it easy for the next few months. Be sure to elevate your feet to reduce inflammation.

Ginger and turmeric should also help reduce inflammation. I ******* hate the taste but I make sure I get ginger in my smoothies at least 3-4 times a week.

 

[typerpinoy]

What kind of doctor did you see? You should probably be on an anti-inflammatory.

 

[AgentZero]

I'm no doc but with cortisone shots, as long as you take it easy and gradually ramp up activity over time you should be good.

A lot of dudes get the shot and feel good so they rush things and end up putting far too much stress on their feet.

Get that shot and take it easy for the next few months. Be sure to elevate your feet to reduce inflammation.

Ginger and turmeric should also help reduce inflammation. I ******* hate the taste but I make sure I get ginger in my smoothies at least 3-4 times a week.

My goal is to get to 100% or near 100% by late spring/early summer so I'll be sure to take it easy for now. I'm just worried that the shot will only do so much and it'll be back to how it's feeling now after it wears off eventually. Who knows though, maybe it'll be the start to getting the inflammation down.

In the meantime, I'm going to work on reducing some of the inflammation through rest and diet. Thanks for the tips.

What kind of doctor did you see? You should probably be on an anti-inflammatory.

I saw a physician who specializes in the foot and ankle.

Right? Inflammation three months later can't be good. The doctor told me to take an Advil or something "as needed" and that was only after I mentioned anti-inflammatories. She even gave me the OK to continue playing sports, which I don't think is a smart idea...

 

[frank mucus]

Get bloodwork to make sure it isn't arthritis

 

[HEATHEN]

Get bloodwork to make sure it isn't arthritis

Word...


I've got an appointment coming up myself and I've been dealing with major pain since December.


I try not to google too much but it does feel like osteoarthritis.


The pain I deal with on the daily is unreal...

 

[minah86]

1) there's no bloodwork for osteoarthiritis. it's a clinical diagnosis. if you're under 50 years old, extremely unlikely that you have it. i'm assuming you are under 50 since you are still playing sports competitively. there are other forms of arthritis but given this pain started after playing sports, again, unlikely.

2) all that medical jargon on the report is non-specific, meaning it says a bunch of nothing other than inflammation. and that's what it probably is. xrays are already great for dx'ing fx's but an mri would've definitely caught it. it's likely you have a bone contusion or metatarsalgia. if it is, then it's just going to take time unfortunately. i know that's not something an active, young adult wants to hear, but it really comes down to rest and avoidance of aggravating factors.

good luck

 

[HEATHEN]

1) there's no bloodwork for osteoarthiritis. it's a clinical diagnosis. if you're under 50 years old, extremely unlikely that you have it. i'm assuming you are under 50 since you are still playing sports competitively. there are other forms of arthritis but given this pain started after playing sports, again, unlikely.

2) all that medical jargon on the report is non-specific, meaning it says a bunch of nothing other than inflammation. and that's what it probably is. xrays are already great for dx'ing fx's but an mri would've definitely caught it. it's likely you have a bone contusion or metatarsalgia. if it is, then it's just going to take time unfortunately. i know that's not something an active, young adult wants to hear, but it really comes down to rest and avoidance of aggravating factors.

good luck

My guy been around since '02 and only comes out the wood works to dispel bro science.


Thank you for the insightful post doc (I'm assuming).

 

[frank mucus]

Bloodwork can tell you if it is or isn't rheumatoid arthritis though.

That's something you wan't to catch on early or else it could eat away at your cartilage could lead to deformities.

But I think you'll be alright since you said it was only your big toe, but it's still better to get it checked regardless.

 

[AgentZero]

1) there's no bloodwork for osteoarthiritis. it's a clinical diagnosis. if you're under 50 years old, extremely unlikely that you have it. i'm assuming you are under 50 since you are still playing sports competitively. there are other forms of arthritis but given this pain started after playing sports, again, unlikely.

2) all that medical jargon on the report is non-specific, meaning it says a bunch of nothing other than inflammation. and that's what it probably is. xrays are already great for dx'ing fx's but an mri would've definitely caught it. it's likely you have a bone contusion or metatarsalgia. if it is, then it's just going to take time unfortunately. i know that's not something an active, young adult wants to hear, but it really comes down to rest and avoidance of aggravating factors.

good luck

I'm not even halfway to 50, so yeah it's probably unlikely.

I googled Metatarsalgia and the symptoms sound very similar to what I'm experiencing. I'll be sure to take it easy for a while. Do you think a cortisone injection would be a good idea?

 

[scrubstoreowner]

sucks that your physicians cant help you correctly and you have to resort to a public forum for help

unfortunately, you are not alone, many doctors today are worthless

I deal with them daily and they usually let me down

 

[utvol23]

Subchondral sclerosis and subcortical cysts are seen in osteoarthritis and are chronic changes not acute inflammation. While you are young for osteoarthritis the mtp joint is a very common location and could be because of some prior injury, caritlage injury etc which can speed up the process. Did the xray mention any of those changes? What was the impression of the Mri?

The marrow edema and joint effusion are consistent with more acute inflammation.

Many types of arthritis but as said before no blood work for osteoarthritis. There are blood tests for Rheumatoid and Gout or needle aspiration for gout but the changes you described on the mri dont really fit with that.

Was the foot and ankle doc an orthopedist or podiatrist?

 

[AgentZero]

Subchondral sclerosis and subcortical cysts are seen in osteoarthritis and are chronic changes not acute inflammation. While you are young for osteoarthritis the mtp joint is a very common location and could be because of some prior injury, caritlage injury etc which can speed up the process. Did the xray mention any of those changes? What was the impression of the Mri?

The marrow edema and joint effusion are consistent with more acute inflammation.

Many types of arthritis but as said before no blood work for osteoarthritis. There are blood tests for Rheumatoid and Gout or needle aspiration for gout but the changes you described on the mri dont really fit with that.

Was the foot and ankle doc an orthopedist or podiatrist?

It might be worth noting that I have extremely flat feet, which I wear orthotics for, and have played a lot of soccer and basketball so my feet get banged up a lot. However, this the first I ever remember pain in this area though and the doctor believed this to be from a recent injury as well.

From what the doctors told me, the x-rays looked completely normal and the impression of the MRI was basically what I typed above, but I'll add the rest:

"...Small first metatarsophalangeal joint effusion. No abnormal marrow edema is seen in the great toe proximal phalanx. Trace marrow edema is seen in the medial hallux sesamoid. No sesamoid fracture is identified. The sesamoid phalangeal and intersesamoid ligaments are unremarkable." That and the cartilage fissuring along the first metatarsal head has an underlying cortical deformity.

The doctor I went to was an orthopedist. Do you think it would be better to see a podiatrist?

 

[HEATHEN]

OP how you doing? Update?


As for me? Rheumatoid Arthritis confirmed.

**** came out of nowhere. The past six months have been hell.


I refuse to take NSAIDs or DMARDs. I'm not going to **** up my heart or risk lymphoma just so I can move pain free.

My only thought is if it's this painful and debilitating right now where the **** am I going to be in 10-20-30 years from now?

 

[AgentZero]

OP how you doing? Update?


As for me? Rheumatoid Arthritis confirmed.

Crazy timing, I actually have a follow-up appointment today with a new doctor I'm seeing. It feels a little better. My calf/ankle of that foot are sore because I still favor it some.

So I ended up going back to the original doctor a few weeks later expecting to get a cortisone injection like she had suggested in the previous appointment. When she saw me it was like she had forgotten what she told me last time and advised against it. She then gave me a bunch of "I don't knows" to questions and told me to give it another 6 weeks.

I was fed up so I decided to see the podiatrist who I went to for a fractured toe many years back. He advised the same rest as the previous doctor, but was much more proactive. He put me on some anti-inflammatories for 2 weeks and I've been taking glucosamine/chondroitin/MSM supplement pills. I also got a prescription for new full-length orthotics. According to his original timetable of 3 months, I've got about another month of rest, but we'll see what he says today and if he'd like a new MRI to track any developments.

Rheumatoid Arthritis sounds rough; I did some brief research on it. One of my friends is currently trying to figure out if he has that as well. Are side effects of those medications really that risky?

 

[HEATHEN]

Crazy timing, I actually have a follow-up appointment today with a new doctor I'm seeing. It feels a little better. My calf/ankle of that foot are sore because I still favor it some.

So I ended up going back to the original doctor a few weeks later expecting to get a cortisone injection like she had suggested in the previous appointment. When she saw me it was like she had forgotten what she told me last time and advised against it. She then gave me a bunch of "I don't knows" to questions and told me to give it another 6 weeks.

I was fed up so I decided to see the podiatrist who I went to for a fractured toe many years back. He advised the same rest as the previous doctor, but was much more proactive. He put me on some anti-inflammatories for 2 weeks and I've been taking glucosamine/chondroitin/MSM supplement pills. I also got a prescription for new full-length orthotics. According to his original timetable of 3 months, I've got about another month of rest, but we'll see what he says today and if he'd like a new MRI to track any developments.


Rheumatoid Arthritis sounds rough; I did some brief research on it. One of my friends is currently trying to figure out if he has that as well. Are side effects of those medications really that risky?

Did any of your doctors order blood work?? You need to find out what your rheumatoid factor is just in case. LMK how that appointment went and def continue to rest up. Believe me, I know exactly how it feels when your body just won't cooperate and all you want to do is continue your routine.


The side of effects of those medications are very risky. DMARDs significantly increase the risk of lymphoma and NSAIDs absolutely wreck people's lives. Approximately 3400 people per year die from NSAID use per year in the US according to the FDA. I don't have a choice though. I have to take something to keep my disease from progressing. If I don't my immune system will start wreaking havoc on my heart and lungs. My hands and feet can also develop serious deformities, google images at your own discretion.

Thing about rheumatoid arthritis is that its name is a bit of a misnomer. It doesn't just afflict ones joints it's an auto-immune disease, my immune system has gone haywire. A more accurate name for rheumatoid arthritis would be rheumatoid disease as the joints are just one of the areas impacted by the disease. People with RA are at elevated risk for atherosclerosis and heart disease. I'll spare you the details on how that works but long story short, this disease and the comorbitides that arise from it kills its sufferers.


For me the worst part right now is feeling good some days to go hard and be active only to be unable to move after sitting or laying down. Some mornings I literally have to hold on to things in order to get to the bathroom or get dressed. I look fine but when people see me having trouble moving they just don't understand. I can't even run around with my kids most days.

Sorry for being verbose. Hope all is well for you.






.

 

[AgentZero]

Did any of your doctors order blood work?? You need to find out what your rheumatoid factor is just in case. LMK how that appointment went and def continue to rest up. Believe me, I know exactly how it feels when your body just won't cooperate and all you want to do is continue your routine.

None of them did. They didn't seem to think it was part of the problem, especially considering my age. Also the joint pain is only concentrated on one specific joint in my foot, it's not widespread.

Yeah I gathered that it was a disease from the reading I did. I see, so you don't take them and it gets worse and if you do it could lead to other problems. Talk about being stuck between a rock and a hard place. From what I read beyond medical treatments, it's important to stay active (when you can), stretch often, and maybe try PT. Man that stuff sounds brutal, sorry you're going through that but stay strong. Hopefully they find a cure or at least develop a less destructive medicine to slow the disease.

As for the appointment it went pretty well. The podiatrist said that I seemed to be progressing based on some of the movement/flexibility tests he did on my foot. He was even tempted to say that I could resume playing sports in another week or two, but wanted to stick with waiting another month to be safe like he had said with his original 3 month diagnosis.

In regards to the soreness in my calf/near my ankle, he said I should continue using a roller on it and could even try PT if I wanted. He also advised that I try something called Arnica, which from what I understand is a muscle-relief ingredient that you apply topically. I'm doing some research on it now and will probably get some to use. Does anyone have any experience with it?

 

[diewitsjames]

you sound like you have more of a musculoskeletal situation than disease process situation(RA). You should ask your doctor to refer you to a physical therapist to check your gait, joint mechanics, soft tissue mobility. "resting" is probably the easiest thing a doctor can say to you to get you to leave the office and charge you big bucks on your insurance without really providing any help. while resting is good, its obvious that you cant just sit for 24hrs/day and have to stand up/walk/live life so you should see a PT asap because this sounds like its getting chronic.