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Anf
Anf's picture
Suspected chronic tendon injury

Hi all,

For over a year now, I've been bothered by a niggle that can range from mild discomfort to significant pain.

This is on the bottom of my foot, under my big toe joint.

I've been to see a doctor and a podiatrist about it, but because I have arthritis in the other big toe joint, caused by accidental injury, they've always been only interested in the arthritic one, largely ignoring the other one. The irony being, the one that is not arthritic is often more painful than the one that is.

This lack of interest in medical terms is why I'm seeking advice.

I've used physio techniques to help with a knee injury and an elbow injury before. There's tonnes of good advice about those common injuries. But I can't find any such advice about big toe tendons.

Any advice?

Chris R
Chris R's picture

Might be sesamoiditis? Just an idea to look into, don't take this as medical advice.

This is just an idea, but I would suggest working on your technique in terms of footwork. You might be putting excessive stress on that part of your foot, causing issues. If I train in a deep stance and impact the ground with too much pressure on that part of my foot, I will get very mild big toe pain. This happened when I trained while very tired recently, and my technique was a bit "off" during that session. So while I don't really know what is causing your problem, perhaps looking at your technique might be a place to start.

Good luck with sorting this out

Anf
Anf's picture

Thanks for the input Chris.

I googled sesamoiditis as you suggested. It looks like a likely candidate.

You're quite right about my technique/footwork. My feet over pronate and I have fallen arches (I have flat feet). That means I have a tendency to end up with toe much weight going through my big toe joints. Outside of training I wear special insoles to support my arches. In class I haven't been.

At home, I've been focusing on posture. It's amazing how misaligned one can become without realising it, until you actually look for it.

An interesting thing I noticed today. Whenever we bend our knees, the general rule of thumb is that the knee should travel in the line if the foot, perfectly aligned. I thought I was doing that, and even regularly consciously check it. Yet today, I noticed even when it feels like I am aligned right, actually my knees are not following the line of the foot. It feels like they are, my eyes say otherwise. So I made very conscious and careful adjustments and unbelievably, my knees instantly felt more relaxed, I felt less pressure on my feet, but weirdly, I felt muscles engaging that I don't normally feel.

I think I have some posture work to focus on :)

Tau
Tau's picture

I'm a health care professional specialising in injuries. I examine feet every day for acute injuries. Yours is more complex by virtue of it being chronic. 

The first principle is.... it's impossible to diagnose without laying hands on you.

Ideas off the top of my head:

1. arthritis. I accept that your other-side arthritis is probably caused by injury but this isn't a given. Arthritis in the absence of injury is usually bilateral (both sides.) You will also be compensating

2. I wouldn't rule out plantar faciitis although it seems too far down your foot. Your dropped arches and use/non-use of footwear is a clue and it's possible

3a. Simple soft tissue injury caused by your described knee malalignment. Rest will correct this

3b. Indeed, tendonitis. 

4. Other

If you were my patient I'd x-ray you to look for signs of arthritis or over other things such as stress fracture. I'd talk to your GP about this as a first option. For a second option I'd consider an osteopath

Hope this helps

Pete

Anf
Anf's picture

Thanks Tau

Tau wrote:
1. arthritis. I accept that your other-side arthritis is probably caused by injury but this isn't a given. Arthritis in the absence of injury is usually bilateral (both sides.) You will also be compensating

I hear what you're saying, but in my case, I smashed the big toe joint to pieces in an accident, then foolishly didn't seek treatment immediately, as I thought I'd just bruised it. Then when I did seek medical advice, foolishly I largely ignored it, believing the doctor was exaggerating. In my extremely feeble defence though, the x ray didn't reveal the fracture. A later MRI revealed that both surfaces of the big toe joint had smashed together with sufficient force to become concave, and one piece of bone had rotated then set in the wrong position. All of this damage had, apparently, escaped detection by x ray due to the fact that the X ray is 2 D and the cross section they x rayed looked intact.

As predicted by the podiatrist, the pain in the arthritic side has become minimal most of the time. Usually a bit sore and achy on a bad day but rarely very painful now. My knee on that side gets a bit sore sometimes, probably because as you say, I'm subconsciously compensating.

Thanks for the suggestions about other possibilities. Certainly gives me something to research. I know I should get it looked at but we keep hearing about the NHS being at breaking point, and in any case, what I found with the other foot is that sadly, they ask you to see a serious of specialists, presumably at great cost to the NHS, only to conclude that the best treatment is a steroid injection.

Under advice from a physio, I was able to remedy a tendon injury in my knee using specific exercises. When I partially tore a tendon in my elbow, I sorted that with exercises involving a resistance band. That's been painted free for months now after months of pain. By that same logic, I've been trying to mend my toe with exercises. Trouble is, feet are almost constantly in use. It's hard to give feet the rest they need to heal.

Tau
Tau's picture

Anf wrote:
Thanks for the suggestions about other possibilities. Certainly gives me something to research. I know I should get it looked at but we keep hearing about the NHS being at breaking point, and in any case, what I found with the other foot is that sadly, they ask you to see a serious of specialists, presumably at great cost to the NHS, only to conclude that the best treatment is a steroid injection.

The thing is research is no substitute for actually getting hands-on. The NHS (and people like me) exist for a reason. Use the service. And maybe steroid injections are appropriate; I’ve Been down that route for injuries