I am in my early 30s and in September of 2013 I was doing a lot of walking on uneven road—at which point I felt a “snap” in my big left toe. The snap/pain was most apparent on the right side of the toe. Within about 5-10 minutes the right side/a good portion of the big toe went numb.

The next day, I could start to feel the toe but it was numb on/off for about a week. Ever since this has occurred 10 months ago, it has never been the same. Wearing dress shoes is extremely painful, so I am forced to wear sneakers everywhere. Even with sneakers however, if I walk too far (more than a couple of blocks) my big toe will begin to hurt and burn. Today, I have pain both under the big toe—presumably one of the sesamoids and the big toe joint itself, there is considerable crepitus in the joint—however, I can still bend it and there are no bone spurs yet.

Icing the toe can relieve the pain temporarily but it is not a permanent fix. I have been to physical therapy for 6 weeks with ultrasound treatment and it has not brought any relief. I've tried taping, a special rubber-like joint protector, a special “alignment” strap to wear at night but nothing has helped.

The podiatrists recommend orthotics with a Morton’s toe extension. My insurance does not cover them so the cost would be $500-$700 depending on who makes them. I have been doing a lot of research on issues with the big toe joint and there are a myriad of solutions to “fix” the problem not all of which are successful. I have had an MRI to which the results are posted below, if anyone can help make sense of them that would be very helpful.

Questions:1. Have orthotics gotten rid of the pain those who have this/similar pain in the big toe joint?2. What are my options if the orthotics do not fix the problem? 3. Has anyone else had a successful resolution to big toe joint pain?4. Specifically, has anyone had a subchondral cyst in their fibular sesamoid, if so, what was the outcome?5. Any advice/recommendations for someone with this problem?

Notes:1. I have consulted with an orthopedic surgeon about this in the past and they were not interested in the forefoot.

MRI RESULTS:

FINDINGS: Minimal early plantar aspect degenerative changes of the fibular sesamoid noted with associated reactive edema or sesamoiditis. Sesamoids appear intacts as does the FHL tendon sheath and flexor digitorum brevis tendons. Phalangeal sesamoid ligaments appear intact with no stress fracture noted or bone contusion noted. Remaining metatarsal phalangeal joints are intact. No neuroma formation is noted. The transverse metatarsal ligament is clearly well visualized and intact and no definite bursal abnormalities are appreciated at this time.

IMPRESSION:1. Subtle focal early subchondral cyst plantar aspect fibula sesamoid without sesamoiditis possibly representing early arthritic changes. No bifid sesamoid is noted nor internal derangement otherwise appreciated.2. No myoedema bursal abnormality or neuroma formation currently suggested on this targeted exam of the forefoot.3. Query subtle osteoarthritic changes related to the first metatarsophalangeal joint.4. Consider protected weightbearing.