Feet Hurt? Get Treatment, Avoid Surgery

It could be predislocation syndrome, and an early, accurate diagnosis now can help prevent the need for surgery later. By Douglas R. Solway, DPM, Advocate Lutheran General Hospital


Everyone suffers from aching feet from time to time.  After all, according to the American  Podiatric Medical Association, people take between 8,000 and 10,000 steps per day, which adds up to walking approximately 115,000 miles in a lifetime.  That’s a lot of work for your feet.

But if you’re feeling a more constant pain in the ball of your foot, perhaps accompanied by a burning sensation, you could have a condition called predislocation syndrome

Predislocation Syndrome

Predislocation syndrome is a slowly progressing condition where the structures that hold the joint of your second toe stable begin to degenerate.  As a result, you will experience frequent pain, burning in nature, in the ball of your foot that results from inflammation of the joint structures. 

Predislocation syndrome occurs prior to the toe joint actually dislocating.  Walking barefoot typically becomes uncomfortable, particularly on hard surfaces, like wood or tile floors.  Sometimes you will notice your second toe has “migrated,” or moved a bit to the left or right.  In extreme cases, the second toe will sometimes cross the big toe. 

Generally speaking, predislocation syndrome causes ongoing pain and discomfort in the ball of the foot that is severe enough to disrupt your everyday life.  Exercising becomes more difficult and painful; sometimes just walking across the floor can become a real challenge.

Who Gets Predislocation Syndrome?

Predislocation syndrome is a common foot ailment.  I diagnose approximately five percent of the patients I see each week with predislocation syndrome.  Although just about anyone can develop the condition, it is more common in people with a certain foot type known as Morton’s foot structure.  This foot structure is typified by a shortened first toe, or big toe, and an elongated second toe that extends beyond the big toe. 

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Frequently, predislocation syndrome is misdiagnosed, and subsequently, ineffectively treated.  Many of my patients have come to me after having been diagnosed with Morton’s neuroma, for instance.  After having been treated with injections, the pain still has not abated and they are seeking additional relief from that pain.  Sometimes, four or five months have gone by before these patients will seek out another diagnosis and treatment.

Sometimes, too much time has passed for non-invasive treatment by the time they receive the proper diagnosis.  As a result, surgery is required.  The key is getting a good diagnosis as early in the process as possible.

Getting a Good Diagnosis

The first step in getting a good diagnosis is recognizing the signs of predislocation syndrome and seeking a podiatrist’s advice.  If you experience any of the following, you should make an appointment with a podiatrist:

  • Pain in the ball of your foot
  • Difficulty walking barefoot, especially on hard surfaces
  • Have to limit your regular physical activity, including exercise, because of the pain
  • Recently increased your physical activity, such as beginning to train for a marathon

After taking a full medical history, your doctor may recommend a diagnostic skeletal ultrasound or an MRI.  Both of these tools are the leading edge of diagnostics for predislocation syndrome.  Importantly, they will rule out Morton’s neuroma, thus substantially decreasing the instances of misdiagnosis.

Treatment: Early Diagnosis is Key

When caught early, predislocation syndrome is easily treated through non-invasive measures.  Over-the-counter anti-inflammatory products and orthotics are useful to reduce the inflammation around the joint.  Icing the foot and good old-fashioned rest are useful for swelling reduction, as well. 

Surgery becomes necessary when conservative care has been exhausted and the symptoms persist.  It is an outpatient procedure that realigns the metatarsal bone and allows for the soft tissue structure to heal in the affected area.  Most patients are back in their street shoes and moving around normally within two weeks.

However, with early diagnosis, surgery can be possibly avoided.  Because predislocation syndrome progresses slowly, it’s easy for people to overlook or dismiss their symptoms. That’s why it is so important to pay attention to your symptoms and, if you think you may have predislocation syndrome, seek a diagnosis from a podiatrist.  Early diagnosis is truly the key to simple, effective treatment.

Douglas R. Solway, DPM, is inPodiatric Medicine and Surger at Advocate Lutheran General Hospital.

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