I can speak from experience that persistent orthopedic pain can be debilitating. Whenever it occurs, I’m forced to put my active lifestyle on hold. In some instances, the discomfort draws negative attention to simple daily movements. Throughout my life, I’ve experienced numerous orthopedic issues—foot, knee, hip, back, and shoulder. Usually, I’m able to connect with a doctor and/or physical therapist who provides an avenue to relief.
I realize that some symptoms and test results may not lead to a clear-cut diagnosis. When my foot became an issue last fall, I never anticipated that I’d need to see so many doctors before I could move forward. By sharing my story about my ganglion metatarsal cyst and providing useful tips, I’m hoping that others will have a shorter journey to recovery.
Almost a year ago, I experienced pain in my right foot. I hesitated to make an appointment with a doctor because I simply hoped the problem would go away. Aches and pains are part of middle age. These annoying symptoms oftentimes disappear without any intervention. I was also simultaneously dealing with knee pain and the possibility of middle age medial meniscus surgery.
The pain in my first metatarsal persisted and over time spread across the ball of my foot to
the other metatarsal bones. Not only did the pain expand, but also the intensity and duration increased. Initially, it was something that I could tolerate. Eventually, the pain became an extremely disruptive element and my calf muscle tightened up. After a few months, I couldn’t concentrate in stop and go city traffic. I had to rely on my husband for long hauls. I spent hours looking for just one pair of moderately comfortable shoes. I’m grateful to the Boulder shoe salesman at REI who recommended my first pair of HOKA ONE ONE shoes.
When I made a doctor’s appointment, I was optimistic that the foot specialist could remedy my issue. He diagnosed sesamoiditis and I was asked to wear an awkward orthopedic boot for 3 weeks and then transition into a new pair of orthotics. I was also advised to return if I wasn’t better in four weeks. I followed up with the physician assistant. An MRI was ordered. I waited and waited for my results to be shared. Patience took on a new meaning, as my calls remained unanswered.
The first pair of orthotics made my situation worse. The pain increased whenever I drove my car more than a few miles or in stop and go traffic. During my return visit, the doctor wasn’t interested in seeing the newly made orthotics. Instead, he ordered a cortisone injection to relieve the inflammation.
While I’m always reluctant to consent to an injection, oftentimes it appears to be the best solution to lessen inflammation. After having numerous cortisone injections in various parts of my body, I know that this procedure doesn’t always guarantee success. However, I never anticipated that the toe pain would reach a crescendo and that I’d be second-guessing my decision. For a couple of weeks, I couldn’t tolerate anything on my foot, including a simple cotton sheet.
Opinion # 2
After the shot had a paradoxical reaction, the orthopedic surgeon started listing different surgical options. My comfort zone was dwindling as he waffled between treatment plans. I proceeded to plan B. With my MRI and x-ray results in hand, I consulted with a more experienced doctor. This doctor was confident that he had the answer, but wouldn’t provide any estimate on a favorable outcome. His dramatic approach included fusing bones together, cleaning out a bone cyst, and cutting a muscle in my calf muscle. My head was spinning with thoughts and concerns. Most importantly, did I want anyone to operate on my foot and my calf?
My frustrations mounted as I looked for Plan C. I shared my test results and my symptoms with another doctor. This time around, the doctor was 95% certain that he had the answer. His cocky response was short and sweet. Clean out the big toe joint and all would be fine. I was handed a consent form for surgery and asked to sign on the dotted line. Yikes. I felt like I was in a car dealership rather than a physician’s office.
I shook my head as I hobbled to my car. My sleep deprivation added to my misery. I needed to find my way out of this maze of medical mumbo jumbo and find a comfort level with a doctor.
Deep down I knew that I had to seek a fourth opinion. But, I also didn’t want to see another doctor. I hemmed and hawed over my options. Several
people offered a referral. Procrastination set in. I eventually made an appointment.
I was pleasantly surprised by this doctor’s approach. Dr. Daniel Moon, the least experienced of the doctors that I had seen, wanted to see the orthotics that I carried to each appointment.
Ah ha…the pair of orthotics was designed incorrectly. Perhaps, there was a simple answer after all.
A new pair of orthotics was made. More time passed. While the pain started to resolve across the adjacent metatarsals, the metatarsal near the big toe continued to be unhappy and the skin would become red whenever it was exposed to warm water or dry heat. The metatarsal pain continued to interrupt my sleep at least once a night.
During a follow up appointment at UC Health, Dr. Moon came to the conclusion that a normally asymptomatic ganglion bone cyst was the most likely culprit. Months ago, an MRI had identified this bone cyst. Doctor B had wanted to merely clean out the cyst and never mentioned the need to fill it. He had also wanted to do a few more invasive procedures. Doctors A and B felt that the bone cyst was irrelevant. Dr. Moon was the only doctor who felt that the bone cyst had to be cleaned out and then filled with cadaver bone. Hmm…once again, I had to analyze several medical opinions.
Doctors Looking for Zebras
Long ago, Dr. Mark Hill, a general surgeon in Highland Park, Illinois, stated that far too often doctors don’t always listen to their patients and ignore the obvious. He casually mentioned this adage— “When you hear hoof beats behind you, don’t expect to see a zebra.” In other words, the hoof beats are most likely coming from a horse, not a zebra. When I was trying to recall Dr. Hill’s wise comment, I found an article that attributed this saying to Dr. Theodore Woodward, a 1940s medical researcher who received a Nobel Prize nomination for his role in finding cures for typhoid fever and typhus.
If my pain was primarily at the 1st metatarsal bone, why would I need to clean out the toe joint, fuse other bones, or have a dramatic procedure done to my calf muscle? While bone cysts tend to be asymptomatic, perhaps this one was causing pain. Even though addressing the bone cyst made the most sense, I remained overwhelmed by all of the medical opinions. Did I have enough information to make an educated decision?
Steps to Analyze Four Opinions
At a follow-up appointment for my meniscus surgery, I shared with Dr. Thomas Noonan the lack of consensus amongst prominent foot specialists. He candidly stated that if I consulted with four more foot specialists that I might end up with even more opinions on the same set of facts.
I shook my head. I didn’t know if I’d ever find a way to stop the pain
In order to move forward, I had to ask myself a series of questions:
- Would seeing one or more doctors be beneficial?
- Did it matter if two or more doctors agreed with a particular approach?
- Didn’t it just come down to having confidence in one doctor?
- Had I found one doctor who I felt had the best answer?
Before consenting to any surgical procedure, I needed to believe that the procedure had a high likelihood of removing the discomfort and that the doctor was competent to do the procedure.
For months, my foot pain wrecked havoc with my daily life. I had no choice but to find a solution. While it ended up taking many months to resolve, I eventually eliminated the chronic pain. Patience was the key.
If I had followed the advice of the first three doctors, I highly doubt that the end result would have been the same. Dr. Moon performed a debridement of the right great toe MTP joint, curettage and a bone graft of right first metatarsal cyst, and also sent a sample of soft tissue for a biopsy. While cleaning out the gooey substance that had eroded the inside of my metatarsal bone, Dr. Moon discovered that approximately one half of my metatarsal bone was missing. If you look closely at his medical instrument, you can see how deep it went inside my bone. I thank Dr. Moon for sharing his photo.
The MRI and bone scan didn’t show the complete size of the cyst. Usually, the first metatarsal bone is the thickest and strongest one since it is the primary weight bearing bone.
When Dr. Moon examined the great toe joint during the debridement procedure, he determined that the right great toe joint was normal. Had I followed the advice of Doctor C, I would have undergone an unnecessary surgical procedure.
From what I have experienced post op, I feel that the bone cyst was the culprit. At 3 ½ months post-op, my pre-surgical pain is gone. After just a few weeks, I was able to sleep through the night. I gradually transitioned from non-weight bearing to a partial weight bearing status to walking unassisted.
Foot surgery recovery can be a slow process. I’ll suggest tips in a future blog. Near the end of this year, the cadaver bones will be fused. I’m optimistic that my recovery will remain on track and that there won’t be any late stage obstacles. I’m looking forward to skiing in December.
With the pain and the surgery behind me, I can be more objective about my collection of diverse opinions. The field of medicine can generate multiple opinions on the same set of facts. Each specialist reaches his conclusion based on prior experience and what is determined to be relevant. Some doctors are unfortunately hearing zebras when they should be looking for horses. Others don’t always take time to listen to everything that a patient says.
I had to find the doctor who provided the best course of treatment. While this process took considerably longer than usual, I realize that the process could have gone on even longer. I’m grateful for the UC Health doctor who recommended that I visit Dr. Moon. I encourage anyone who is going through a similar experience to persevere until they find a comfort zone with a specialist.
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Can you relate to the zebra adage? If so, please share your story below.
Meaningful Anniversary (hip replacement)
Sandra Bornstein is a freelance travel and lifestyle writer. She shares her experiences and recommendations on this blog and on other websites. She also has a secondary website, TheTravelingBornsteins that exclusively focuses on travel. See https://thetravelingbornsteins.com.
Sandra contributes a monthly travel tip column for Golden Living, a Best Version Media magazine and is also a contracted travel writer for Fareportal’s online sites—One Travel Going Places and CheapOAir Miles Away.
Sandra is the author of MAY THIS BE THE BEST YEAR OF YOUR LIFE. This memoir highlights Sandra’s living and teaching adventure in Bangalore, India. As a licensed Colorado teacher, Sandra has taught K-12 students in the United States and abroad. She also taught college level courses.
Sandra’s memoir was a finalist in the Travel category for the 2013 Next Generation Indie Book Awards, the 2013 International Book Awards, the 2013 National Indie Book Excellence Awards, 2013 USA Best Book Awards, and a Honorable Mention award in the Multicultural Non-Fiction category for the 2013 Global ebook Awards.