Tendonitis? (recurring) problem

[catwoman]

Since the last week of July, I've had 4 episodes of swelling, pain & bruising on my right foot, right near my small toe. Each time the problem didn't surface until I woke that morning, got out of bed and thought I had something stuck to the bottom outside of my foot near the small toe. Swelling throws off my balance because I have had to walk with my foot pronated. Within hours of waking up, there is bruising around the swollen area. The first time was the worst and at the time I suspected I had broken some blood vessels because the discoloration spread to under the foot. I had a recurrence several weeks later; intended to go to PCP that day, but I had to fill in for an absent co-worker that day.

I finally called my PCP's office last Thursday; he was booked up but I got in with the nurse practitioner within 2 hours. NP found where the pain was and suggested RXing me anti-inflammatory agents. I reminded her I'm on warfarin and she backtracked on that. Remember a thread here several weeks ago, I asked about Alleve and she said nope, nada on NSAIDs. She ordered an X-ray and RXed Vicodin (sp?) & said it could be stress fracture, could be tendonitis. She double-checked with PCP, who theorized stress fracture & said no on anti-inflammatory RX pr OTC. Also said to wear extremely cushiony shoes with a lot of shock absorbency.
I was given work note to stay home until today.

X-ray was negative -- but I know stress fractures don't always show up on X-rays. Discoloration pretty much gone, but tissue around the area still seems swollen. Pain now gone.

This is probably going to be like a car making a noise when you drive it but not when the mechanic checks it out. However, I will be pursuing the problem with my PCP's office and getting a referral to an orthopedic specialist or a podiatrist.

Surprisingly, discoloration has only been bad the first time.
I think Alleve would do me more good than the Vicodin and am tempted to take it w/out my doctor's OK. I had the Vicodin RX filled, and did ask the pharmacist about using Alleve instead. He sided with my PCP and NP.

My dilemmas are (1) getting to the root of the foot problem and (2) persuading my PCP that it is OK for me to take an anti-inflammatory in certain instances to remedy the situatin rather than treating a symptom (pain). I don't have any GERD problems and I wouldn't be taking Alleve for that long ... I think. I do home-testing, so I can watch for any fluctuations in my INR.

Any feedback on NSAIDs/anti-inflammatories? Anyone have a similar foot problem before?

 

[geebee]

Marsha,

I have broken my left foot twice, once a stress fracture, the other an out and out break. Every so often, my foot swells for no reason and, like you, I usually notice it in the morning. The doctor tells me that this could happen forever since my foot was injured. Apparently, since the foot is at the bottom of the gravity chain, any excess stress, weight (such as water build-up) or even sleeping in a different position can cause this to flare up. I have always just used tylenol and soaking to help with the pain. The swelling goes down by itself in a couple of days.

All of my doctors have said no NSAIDs while on coumadin.

 

[PJmomrunner]

Hi Marsha:

Your toe/foot sounds very painful. I searched for a thread where I thought you talked about shoe discomfort in the past, but I couldn't find it--maybe I'm imagining things???

Anyway, in the past I had a foot problem when training for a marathon and in researching my problem I found out that the root of many foot problems (and back and knee and hip problems as well) is in the shoe. Specifically, most problems stem from a lack of proper support for feet that over-pronate, or move too much. Most people are over-pronators to a greater or lesser degree and the more one's foot over-pronates (moves), the more one's shoe needs to discourage movement. Athletic shoe companies make running shoes for over-pronators called "stability" shoes, or for people who really over-pronate called "motion control" shoes. They also make shoes called "cushioned" shoes for people who under-pronate--to encourage movement in a sort of stiff foot.

People who over-pronate usually have low arches or even flat feet. When they stand at rest their feet usually form a "V," with the toes pointing outward, and their shoes usually wear first on the outer heel. Underpronators are the opposite--high arches, toes point in, and inner heels wear first.

If you are an over-pronator, you might benefit from a shoe with good arch support (Good luck finding one! Chaco sandals are excellent, Birkenstocks are also very good and Keen sandals or shoes are great as well--unfortunately none are lovely or cheap ). Superfeet makes a great over-the-counter orthotic for about $30 that can be added to any shoe. Any real running shoe store (as opposed to a large sporting goods or sport shoe store) where serious runners buy their running shoes will be able to assess your gait and recommend a good running shoe, if you don't mind wearing a running shoe (expect to spend $100+).

If you are an over-pronator, I'm told any cushiony shoe will do. Cushiony shoes tend to be less expensive too, less structure to them, I guess.

This, of course, is a whole lot of conjecture on my part. Can you tell I really wish I could run?

I'm sorry your foot hurts.

 

[Mb]

Hi!

This sounds suspiciously like how my husbands foot looked/felt this past summer. DX'd with cellulitis. His whole foot was affected though. Looked bruised, tender, swollen, some minor petechia. I'd get the Dr. to look at it again. Just an idea. - Marybeth

 

[Guest]

An NSAID isn't really a cure. It relieves inflammation.

You are right that Vicodin blocks pain perception and really does nothing as far as inflammation is concerned.

 

[terryj]

My husbands knee became very swollen 2 years ago and he was diagnosed with tendonitis of the knee. It was swollen,warm and painful to the touch. His doctor also started to give him a prescription for an anti-inflammatory drug and I reminded him about the coumadin also. He told him to try Tylenol Arthritis and keep his knee elevated as musch as possible for a few days. It took about a week for it to totally go away. He just went to bed one night and woke up the next morning with his knee swollen twice its size,red and warm.

 

[catwoman]

P.J.:

Your memory is right. I was in orthopedic shoes from about age 8 to 13 -- I think for extreme pronation or something like that. I remember crying a lot about my foot pain. At 13, I wanted to wear shoes like my friends were all wearing, and my mom caved in to my pleas.
I had a bunionectomy on both feet at age 29.
I bought a pair of running shoes at a store that caters to serious runners, recommended by a vr.com member, Tom Hosack. And, yep, they were at least $100.
My PCP was booked up late last week, so that's why I saw his nurse practitioner. I **am** going to get into see him later this week.