According to the American Podiatric Medical Association, the average person takes around 9,000 to 11,000 steps each day. With this constant use, no wonder the feet are susceptible to pain. In addition, many back and nerve-related conditions cause foot pain.
What is the role of feet?
Your feet support your weight, propel the legs forward, act as shock absorbers, and help you keep your balance on uneven surfaces. Pain can occur in any portion of the foot, from the toes to the back region of the heel, or it can be on the bottom of one or both feet. Some foot pain is temporary and mild, whereas other foot pain is persistent and more severe.
How common is foot pain?
Based on statistics from a recent survey in America, around 50% of people report that they do not exercise because of foot pain. In light of the rising obesity rates in the U.S., this makes foot pain a serious problem.
What are the grades of foot pain?
According to the American Podiatric Medical Association, there are four grades of foot pain. These include:
- During activity
- Before and after activity (not affecting performance)
- Before and after activity (affecting performance)
- Pain that prevents activity
How is foot pain related to the back and spine?
Many people have foot and lower leg pain that is caused by nerve root compression. The nerves are located between the lumbar (lower spine) vertebrae L4, L5, and S1. These particular spinal nerves control the sensory and muscle perceptions of the feet. Many neurological syndromes associated with these nerves can cause foot pain, such as radiculopathy and sciatica.
What causes foot pain associated with the back?
Usually, a person has some type of spinal abnormality that causes manual compression of one of the lumbar or sacral nerve roots. Bony prominences and misplaced vertebrae irritate the nerves where they exit the spinal cord. Conditions that cause nerve root compression include:
- Herniated disc
- Foraminal stenosis
- Spinal arthritis
- Lumbar spinal stenosis
- Bulging disc
What other conditions can cause foot pain?
- Neuropathy – Various types of neuropathy can lead to foot pain, such as peripheral and diabetic neuropathy. With neuropathy, there is oxygen deprivation of the spinal nerve roots.
- Poorly fitting shoes – Too tight, confining, or too loose.
- Overuse of feet – Walking, running, or standing too much.
- Achilles tendonitis – Stiffness and pain of the tendon at the heel region.
- Bunions, corns, and calluses – Various hardened formation of the foot.
- Flat feet – Lack of arch and no support.
- Bursitis – Inflammation of a joint bursa (sac around the joint).
- Stress fracture – Tiny, hair-line fracture of one of the foot bones (tarsals or metatarsals).
- Gout – Accumulation of uric acid in the joints.
- Hammertoe and mallet toe – Foot deformities that are related to an imbalance in tendons, muscles, and/or ligaments that hold the toe straight.
- Morton’s neuroma – Affects the ball of the foot.
- Metatarsalgia – Pain at the front of the foot associated with sporting activities.
- Plantar fasciitis – Inflammation of the plantar fascia that supports the foot.
- Tarsal tunnel syndrome – A compression neuropathy affecting the tibial nerve that travels through the tarsal tunnel.
What symptoms are associated with foot pain?
Other than pain, symptoms include tenderness with touch, bruising, swelling, foot weakness and numbness, loss of function, changes in skin and/or nail color, foot stiffness, and limiter range of motion. Symptoms vary depending on the cause of the foot pain.
What are the risk factors for foot pain?
Certain conditions, events, and situations put a person at risk for foot pain. Risk factors include:
- Female gender
- Herniated lumbar disc
- High-impact activities
How is foot pain treated?
The goal of treating foot pain at a top Chicago pain clinic is to address the underlying cause. Treatment options include:
- Medications – Certain inflammatory conditions respond to nonsteroidal anti-inflammatory drugs (NSAIDs), such as ketoprofen and ibuprofen.
- Orthotics and special shoes – Orthopedic devices include rubber heels, thick soles, support arches, and other special shoe inserts that support and cushion the foot.
- Night splints – To keep the foot in a stretched position, a special night device is worn. These are affective for plantar fasciitis.
- Extracorporeal shock wave therapy (ESWT) – This involves low-dose sound waves emitted to the foot tissues, which triggers a healing response by the body. Research shows this is effective for heel pain. In a recent double-blind, randomized controlled trial with 40 participants, focused extracorporeal shockwave therapy (0.25 mJ/mm) was found to have a 73% efficacy rate for reduction of composite heel pain.
- Epidural steroid injection (ESI) – With this procedure, the doctor injects a corticosteroid with or without an anesthetic into the space surrounding the spinal cord. This procedure is useful for nerve compression pain. In a recent clinical study, the success rate for ESI was 84%.
- Botox injections – To paralyze muscles of the foot to reduce pain with impact activities and walking, Botox is injected around the foot.
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Gollwitzer H, Diehl P, von Korff A, et al. (2007). Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device. J Foot Ankle Surg, 46:348-357.
Hawke F, Burns J, Radford JA, & du Toit V (2008). Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev, 16:(3):CD006801.
Vad et al (2002). Transforaminal epidural steroid injections in lumbosacral radiculopathy. Spine, 27, 11-16.