To be mystified about foot pain and all the possible reasons for it?

[leafgreenborder]

I’m reasonably medically literate but so confused. My issues are as follows:
-Pain in both big toe joints, worse on one side, very painful if I bend them when weight bearing. There’s a loss of range but not fully.
-My feet are very painful in the ball area and generally very achy after walking/ standing.
-I have had custom orthoses made by a specialist shoe shop, these can feel like a relief initially but when I wear them a lot the pain just continues. I don’t think I have fallen arches and at rest my arches look fine.
-I have no heel pain.
-I am a healthy weight (just over 8 stone).
-I’m mid 40s
-Perimenopausal and on HRT

Everything I’m reading seems to say plantar fasciitis but I don’t think my symptoms fit with that. Ditto get custom orthoses- I have them. Ditto lose weight- I’m not overweight.

Does anyone have a similar experience or offer me any suggestions? Thank you.

Several years ago was treated under the NHS for months with no success or proper diagnosis. A casual remark as I was putting my shoes on at the end of my appointment to my genius chiropractor/acupuncturist, who said he'd take a quick look.
Sorted - blissfully pain free after almost a year.
still no idea what it was.

My foot pain went away when my oestrogen dose was increased. I hadn't realised it was a peri symptom until it went away.

One of the first signs of RA for me too.

@Mozza77

Go see a podiatrist, get gait analysis done and casts of feet and then orthotics.
my feet look like I have bunions on the outside of my feet, nope, actually my joints as I have too much bone in each toe. Which has resulted in hammer toes and shortened Achilles. Step extensions help massively as part of the physio relief, the right orthotics (which are recast every 6-12 months)

What are step extensions please?

Are you able to recommend your podiatrist - sounds like they are good? where are you based in the country? Please feel free to send me a PM if you are willing to recommend your podiatrist? Had mixed results with a podiatrist myself. had orthotics but done by eye rather than casts. thanks.

Step extensions are when you hang your heels off the edge of a step so your heel hangs down and then raise up onto your toes. Helps lengthen the Achilles which causes me loads of pain.
slap bang in the middle of the country…I won’t name him here, if it’s a doable location, happy to send his details. Casts by eye? That’s crazy! Feel free to message me

@Mozza77 thanks I will message you.

Thank you again for all of the suggestions. I saw the Podiatrist earlier today. I was concerned he would suggest more custom insoles for several hundred pounds but he actually didn't in the end. He said the main issue is with the big toe joints and I have the beginning of small bunions on both big toes (I did think it looked a bit like this but it is slight and there isn't a really noticeable curve compared to some people I have seen). He said my current insoles are ok for comfort as they support the arch but that this doesn't alleviate the pressure on my toes/ ball of foot. I asked if these changes are related to arthritis and he said yes and it's a case of doing what you can to manage the symptoms. He suggested cushions that go under the toes/ ball and gave me a recommendation for a specific type to get.
I have a bit of arthritis in a few other places so it is disheartening. I might need to look into getting my oestrogen increased in HRT as this might help. I had bloods done for inflammatory markers etc a while back and these were very low so it is probably osteoarthritis.

I have fallen down an internet rabbit hole trying to understand what are bunions vs what is foot arthritis (bunions can be from arthritis, you can have arthritis without bunions and you can have bunions without arthritis). I did biology in school but I find this stuff baffling.
I was recently told I have definite arthritis in my jaw, confirmed on xray. The consultant said it was osteoarthritis but he wasn't sure if it was active or not. Then he tried to explain what active vs not active meant and I just had to pretend I had understood in the end. I DO understand rheumatoid arthritis being active/ attacking via an autoimmune process but the "wear and tear" explanation of osteoarthritis makes no sense to me. I'm in my 40s, why are these areas "wearing out" on me but not everyone and in some parts of my body but not all? Maybe I need to find a good book about it to learn about it in more detail.

I'm just starting on this journey - foot pain under the ball of big toes right worse that left - assumed it would get better by itself but it got worse and I booked to see a podiatrist last Friday - she said I have hallux limitus and it could progress to hallux rigiditus if I don't wear the right insoles /shoes and never walk bare foot again! I'm going to see a second podiatrist at the end of December so I can report back but she was so fast and spent so little time with me I felt I needed a second opinion- it may be that she was fast as it was so obvious so we will see what the next one says...

Hallux Limitus
Painful but not harmful. You may need a different type of orthotic that limits movement through the joint. For footwear that will make you massively more comfortable, look up Rockerbottom shoes. FitFlop are a personal favourite for this condition.

When my foot thing began, I was told that the fat pads under the balls of the feet start to wear out in women in their forties, depending on the level of wear the feet have had - so if you wore high heels, if you'd done ballet, were a keen walker, etc...

I do think it is worth getting at least an ultrasound done. My problem was misdiagnosed by a GP and a podiatrist for several years. Cortisone shots under guided ultrasound can be really helpful for some.

He suggested cushions that go under the toes/ ball and gave me a recommendation for a specific type to get

Which ones did he recommend? Have you a link?

He recommended Epitact plantar cushions, possibly because that’s what’s stocked locally. They are on amazon. They seem a bit flimsy on first impression and I think I might need to try a few types.

That’s interesting, what was it initially diagnosed as and what did it change to? I am due to see him again so I will ask him about some kind of imaging. I was wondering about an xray since he said it’s in the big toe joints.

Thanks those suggestions are great. I will look into some better footwear also.

Sounds like we are in the same boat! My consultation was also fast but seemed thorough. It actually would be interesting to see what another podiatrist would say 🤔

No problem @leafgreenborder when looking for shoes, you would benefit from a rigid soled shoe. I.e. not a shoe you can bend in half.