Transfer metatarsalgia ?

I subsequently underwent two MRI scan examinations in the end, the first didn't include enough detail on my forefoot to accurately determine if it was fractured or not......
I visited my consultant to receive the verdict & much to my surprise no fractures were seen, stress or otherwise. My consultant expressed his surprise at this result, stating that he was as sure as I was that a stress fracture would be the culprit of this latest bout of pain. My consultant involved another specialist when reviewing my MRI images & after discussions & a diagnosis elimination the consensus of opinion appears to be that I am suffering from transfer metatarsalgia............

This is believed to be the result of the mid foot fusion that I underwent as part of my Lisfranc surgery, essentially my 2nd, 3rd & possible 4th metatarsals are now too long. The bio dynamics of my foot have altered following the surgery apparently & this has resulted in a change to how my weight is distributed within my foot & how my foot manages this. Additional length in my metatarsals will cause them to weight bear beyond the amount they should, this also causes the metatarsal heads to become inflamed thus causing significant pain & discomfort like I have been experiencing within my toes. So the prescribed course of action is to first wean the foot back out of the boot & into my MBT's (Fitflop). When I can walk relatively comfortably I will then meet with a physio who will fit a metatarsal bar into my shoes. This should relieve the pressure in my toes. The metatarsal bar will get my foot back into proper alignment when I stand or walk, it simply takes the weight off of the metatarsal bones which should relieve my pain instantly.
Failing this then a metatarsal osteotomy would be required to permanently shorten my toes- Eeek !

It has now been 17 days since I put the boot back on so I decided to try a day without it yesterday, the result was quite a bit of building discomfort in my mid foot, particular increase in acute pain when my foot was positioned with the weight into the heel & lower than my fore & mid foot. The foot was quite red & puffy afterwards, although this settled down after a couple of hours. The building pain is significant enough however to prevent me from walking for any length of time at the moment. The feeling in my mid foot is quite bizarre, more of a nerve sensation, similar to when you have burnt yourself & the area affected projects that tingly slightly numb sensation. When I touch it it feels like this too, so I am wondering if the real problem lies within the mid foot area. but I am not a doctor so I feel obliged to follow the advise given & hope for some improvement. I am back in the boot today to give it a rest & will try again to hobble about without it for a few hours this afternoon.
It is a worry as I have had to take time off from work again & even now I am working from home, this cannot be a long term arrangement as my role requires me to visit customers on site & to travel significant distances. My company will not support me indefinitely I don't think & let's face it at the moment I am not able to fulfil the role I was employed for :-(

But I realise that I must focus on my long term health & recovery as my family & friends advise me to, if I need to change employment due to this injury then I will, there is very little that I can do about that except heed advice & try to recover as best as I can, the foot is in the driving seat at the moment, well that's what it feels like anyway !

Return of the boot !

Ello, ello, ello,

Yes it's been a while hasn't it ?
I was so astonished to see that I'd had over 4000 hits when I logged on last night !
Thanks to all of you that have read my woeful tale :-) I have been quite miserable in some of the posts I've made ,I noticed, but then It's been a crap year for me ! A Lisfranc fracture is not funny & I'm not superstitious but I do find myself being careful around mirrors & ladders these days !
It has been probably the most difficult & challenging year of my life, not just because of the foot....
Where shall I start to bring you all up to date?
I think where I last left you will probably make the most sense....

Sadly I haven't been away pirouetting on the foredeck, or trekking up Mount Kilimanjaro :-(

When I returned from my road trip to the US last October, I learnt that my dear Grandfather Pete was seriously ill, so ill in fact he died just three weeks later. This event was devastating to me, more so than the consultation with Mr Ritchie last April when I learnt the full extent of the damage to my right foot.

We were best friends you see, really true best friends.
When together we were always in cahoots, giggling together about the silly daft things that our mutual sense of humours connected on, often hiding away together when I was a young child in his woodworking shed from my quite strict Gran when she was on the war path !
In fact I think my Grandfather gave me my love of the sea & all things salty ! As soon as I was old enough to walk he got me a life jacket & took me sea fishing with him off of the coast of Hastings in East Sussex. This was the way I would spend most of my summer holidays with him right up until the age of 13 or 14. My grandfather taught me all of the essential things that a young lady should know, like how to thread lugworm onto a fishing hook, how to cast a decent line, how to tell the difference between a Flatty & a Plaice (fish!) & of course how to tell a decent pint of beer from a wrong 'un', although not this lesson until I was of the legal age to consume alcohol of course :-)
I experienced my first man overboard with him on Emma 1 (of course it was me) & my first rescue by the RNLI when the new radio he'd installed on Emma 2 failed when we were out at sea. My grandfather found this event most exciting & whilst I was being uplifted from the boat by the RNLI, he got his camera out to photograph the entire proceedings- LOL

So it all came as a huge shock to me, to lose him so quickly & unexpectedly, the foot actually became second priority to my grief for the best part of six months. He'd appointed me as his executor in his will as my Gran had died 14 years previously. I carried out all of his wishes as best as I could & then after much soul searching I decided to leave my birth place- Tunbridge Wells for a fresh start. I found a house in Addlestone, Surrey, closer to my work, my son, the rest of my family & my man. Yes, my man did hang around (see earlier posts about my worry & self doubt) & he has proven himself to be my rock during this difficult period. I often wonder at his unwavering support & faith in me as he'd only known me for a few months before my life was turned upside down.
I moved to Addlestone on April the 4th, the house is lovely but a project. It needs extensive redecoration & repair as well as having a garden that needs designing from scratch. So I spent the first three weeks in April decorating & cleaning the house with my man in earnest & we travelled to London on April 22nd to watch a great friend of mine compete in the London marathon. The foot was behaving well, a little tender at the end of the day but that was about it. I discussed climbing Mt Snowdon with my friends that evening, I planned to join the local gym the following week & my man had just booked me a trip to Hawaii in October this year to celebrate my 40th birthday.

Then on April 27th after a few days of feeling a little more tender than usual I got out of bed & upon standing I experienced acute pain through my 2nd & 3rd toes. I presumed that I'd just overdone it, I took some Ibuprofen (Aadvil to all you Americans ) & continued with my day hoping for the best.  On the Monday evening (30th) I caved in & drove myself to the local hospital casualty department, by now walking was extremely difficult, I couldn't bend my big toe at all & the pain wasn't responding to the Ibuprofen. I had a standard X-Ray & it didn't show any fractures (neither did the one I had last September) but the doctor decided to refer me to the fracture clinic the following Friday as a precaution in view of my history. I declined the offer of Tramadol & decided to persevere with the Co Codamol & Ibuprofen that I had stocked up at home.
After driving some 700 miles for work over the next three days I arrived at the Fracture clinic sore & feeling slightly unwell. I met Mr Monk- an Orthopaedic & Trauma consultant who browsed my X-Rays with considerable interest & read the letters I'd taken with me that detailed the details of my original injuries, previous surgery & then the second fracture in September. He informed me that he was very experienced in Lisfranc injuries & expressed sympathy at my latest predicament. He recommended an MRI examination & a referral to his private clinic as the current waiting list for the NHS service was around six weeks. Luckily my health insurance provider approved this & it was arranged for the following Tuesday (8th May). Mr Monk also strapped my foot back into an Aircast boot & presented me with another pair of crutches, precautionary but essential as was the ban on driving he explained :-)
Oh the irony wasn't lost on my either, the date ? Well it was the 4th May, exactly 13 mths since my original injury..........
So I had the MRI & met with Mr Monk this evening for the results, the good news, no fractures detected, the not so good news was that the radiologist omitted my toes from the scan ! Mr Monk puzzled over my symptoms, he commented that I was a mystery as both he & the expert radiologist he'd asked to interpret & report on the MRI were convinced as was I that I'd developed a stress fracture in either my 2nd, 3rd or 4th metatarsal. A second MRI of the front of my foot has now been booked for next Monday (14th May) with a further follow up consultation booked for the 15th with Mr Monk.  Morton's Neuroma was also mentioned by Mr Monk as a possible diagnosis;

Morton's neuroma is a condition that affects the nerve between the toes. The nerve becomes irritated and compressed, which results in severe pain on the ball of the foot and at the base of the toes.
Morton's neuroma usually affects the nerve between the third and fourth toes. It is rare for more than one nerve or foot to be affected apparently.

So A further week of minimum weight bearing, in the Aircast & no driving awaits me now. I have limited Internet access at home due to no WiFi as yet so I re subscribed to SKY TV today just to relieve some of the boredom. I will have to sit on my hands to stop myself from getting up & grabbing a paintbrush or doing any more of the various DIY jobs that are outstanding in the house. I must admit I'm now doubting myself, I pondered on the way home if the pain really was that bad or was it just me being nervous about the foot ? When I got home I removed the boot & tried to walk around the house, yes the pain is still there, between my 1st & 2nd metatarsal, maybe not as acute as it was but enough to prevent me from walking normally. So I will just have to await the verdict on Tuesday.

I also received the results from my bone densitometry scan (DEXA) that my GP referred me for a month ago this week. It appears that I do have signs of Osteopaenia in my lower spine so it's a lifestyle change for me, from now on a careful diet & a lifetime's supply of Acal D3 (Prescription Strength Calcium & Vit D)! When my time comes to enter the Menopause then I will need a rescan & possibly more of the Alendronic Acid that I had following the fracture last September (Oh the joy !).

The positives; Well it's an Olympic year here in Blighty, Oh & we have the Queens Diamond Jubilee to look forward to ! Yay !!!!!!!!!!!!!