Diagnosis and Treatment of Left Foot Pain

Diagnostic Imaging

The American College of Radiology recommends MRI of the left foot without IV contrast as the most appropriate next imaging study to fully characterize both pathologies and guide treatment planning 1, 2
For the 1st TMT joint, MRI should assess cartilage loss severity, subchondral bone changes, synovitis, and joint instability 1
For heel pain, MRI should evaluate plantar fascia thickness, focal echogenicity changes, perifascial edema, and exclude plantar fascia tear 2
MRI should also rule out other pathologies such as Baxter's neuropathy, tarsal tunnel syndrome, calcaneal stress fracture, and occult fractures 1, 2

Ultrasound can assess plantar fascia pathology with 80% sensitivity and 88% specificity, and allows dynamic examination 2
Weight-bearing radiographs have already been obtained and show the degenerative changes; CT may add value for surgical planning of the TMT joint but is not essential initially 1

The American College of Radiology and Praxis Medical Insights recommend initial conservative treatment for 3-6 months before considering surgical intervention, unless there is severe instability or disability 2
NSAIDs can be used for pain and inflammation control in patients with 1st TMT joint arthritis 1
Stretching exercises, orthotic devices, night splints, physical therapy, and NSAIDs can be used to treat plantar calcaneal enthesophyte/plantar fasciitis 2
Surgical excision of the enthesophyte and release of the plantar fascia is reserved for cases refractory to at least 6 months of conservative treatment 2

Obtaining MRI before committing to surgery ensures no occult pathology is missed and allows proper surgical planning 1, 2
Weight-bearing radiographs are essential, as non-weight-bearing films may underestimate the degree of TMT joint instability and malalignment 2