Foot Pain

Research studies have shown up to 75% of Americans have experienced some type of foot pain in the past year. The structure that comprises the foot is made of 24 bones. The bones of the foot are connected by ligament tissue.foot pain

The muscles of the feet are the secondary support of the lower extremity mobility and function. Pain is an alarming indicator something is wrong, either structurally, internally, or biomechanically.

 

What are the primary causes of foot pain?

 

Injury or trauma to the area may be the cause of acute pain; chronic pain may be from a condition.

  • Toes: inflammatory arthritis is the main cause of pain in the toe (tarsal) area. Uric acid may cause crystallization in the knuckles from gout, an extremely severe pain accelerated by walking.
  • Heel: part of the foot that gets the most attention is the heel. The plantar fasciitis tissue connects the toes and forms the foot’s arch. When inflammation or irritation flares up, patient may experience pain simply by standing up or attempting to walk. Pain in the heel can be debilitating. Heel spurs also occur in the heel or ill-fitting shoes or unbalanced gait.
  • Arch: flat-footed or fallen arches are the main cause of pain in the arch as they have no protection from impact when walking. Each step has an impact on the arch.
  • Ball of the foot: Metatarsalgia is an inflammation of the ball of the foot, usually as a result of frequent to activity or strenuous use. The tissue can thicken into “Morton’s Neuroma” and cause nerve pain.

 

How can foot pain be treated?

 

A patient’s life and work habits would have to be evaluated to come up with the proper treatment plan to keep the patient off their feet to heal as much as possible.

    • Bed rest combined with anti-inflammatories and over the counter painkillers will help canstockphoto8014652with pain and swelling. Elevating the feet above the heart level also help with swelling, as well as soaking them in Epsom salts and warm water. Only short term bed rest is prudent.
    • The patient has lost functionality and mobility is limited, physical therapy may be recommended to rebuild flexibility and strength. Exercising the arch of the foot can be effective in maintaining blood circulation to the area.
    • For some conditions, shock wave therapy may provide pain relief. This may include plantar fasciitis.
    • Bracing may be helpful for pain relief.
    • Steroid injections may help block pain signals and help reduce inflammation.
    • Patients suffering from gout related swelling and inflammation may benefit from dietary changes.
    • Stem cell therapy and PRP (platelet rich plasma therapy) have shown promising results in recent studies in rejuvenating blood flow to the area.

 

Top Ten Nonoperative Foot/Ankle Pain Treatments

The pain and stiffness of arthritis and other foot and ankle conditions can be debilitating.  Around 25% of the bones in the body are in the feet and ankles. The average person walks about 100,000 miles during his/her lifetime, so no wonder foot and ankle pain is common. In addition, 20 million people are affected by some type of arthritis. Here are the top 10 nonoperative foot and ankle pain treatments.

Special Shoes

For patients who have foot deformities, pain, and stiffness, special shoes can be developed. If the toes have begun to stiffen or curl, shoes with an extra deep tow box will help. A soft arch support and a rigid heel can relieve some types of foot pain.

Well-Padded Splint

When the talus bone of the foot becomes fractured, it often does not heal properly, which can affect ankle and foot function later on. A talus fracture can cause bone collapse and chronic arthritis. A well-padded splint will help, which is applied around the back of the leg and foot from the toe to the upper calf.

Orthotics

These devices include shoe inserts, ankle braces, and foot pads. Shoe inserts are placed inside the shoe to alleviate flat feet and pain related to arthritis. Ankle braces can be worn to offer support to weak ankle joints. Food pads are placed on the shoe sole, and they alleviate pain related to arthritic conditions.

Plantar Wart Removal

Some foot pain is related to plantar warts, which occur on the bottoms of the foot. The doctor can apply a strong chemical to remove the warts, or use cryotherapy to freeze them. After treatment, the wart will often resolve within 2-3 weeks.

Short Leg Casts and Walking Boots

For patients with posterior tibial tendonitis, a walking boot or short leg cast can be used. The goal of these devices is to rest the lower leg and decrease inflammation. The boot or cast provides a stiff platform for the foot and limits motion between the rear foot and mid foot.

Medications

For foot and ankle pain, commonly prescribed medications include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – These drugs reduce inflammation to ease pain. Examples include ibuprofen and ketoprofen.
  • Corticosteroids – These drugs are used short-term to alleviate inflammation due to systematic inflammatory disease, such as rheumatoid arthritis.
  • Analgesics – For serious pain, opioids can be prescribed to relieve discomfort. Many topical agents can help, such as Capzasin, Aspercreme, and Voltaren gel.
  • Disease modifying anti-rheumatic drugs (DMARDs) – These drugs are used to treat psoriatic arthritis, rheumatoid arthritis, and lupus, which all affect the small joints of the feet and ankles.
  • Gout medications – To reduce levels of uric acid and prevent joint pain and inflammation, gout medications may be taken.

Physical Therapy

The physical therapist uses various techniques to improve foot and ankle pain, such as tilt-board exercises and strengthening exercises. This restores range of motion and improves perception of joint position.

Steroid Injections

A steroid can be injected into the foot/ankle joint to reduce swelling, improve joint function, and alleviate pain. During the procedure, the skin over the joint is cleaned with a topical solution, and a local anesthetic is used to numb the area. X-ray guidance is used to assure correct needle placement. The joint is injected with a corticosteroid with or without an anesthetic.

Extracorporeal Shock Wave Therapy

Shock wave therapy is a noninvasive therapy used to relieve pain associated with Achilles tendonitis (degenerated tendons) and plantar fasciitis (heel pain). This involves use of high-energy acoustic waves that deliver a mechanical force to the body’s tissues. The shock waves create a force that induces healing of the tissues. A probes is placed on the skin to conduct the high- and low-energy energy waves.

Epidural Steroid Injection

Some patients with spinal disease have radicular pain, which radiates down to one foot or both feet. The doctor can inject the epidural space (which lies outside the spinal cord) with a steroidal agent. This decreases nerve root inflammation and relieves pain. In a recent study, patients reported more than 50% reduction in pain following an epidural steroid injection. This procedure has an 88% success rate.

Resources

Foot.com (2016). Foot facts. Retrieved from:  http://www.foot.com/site/professional/foot-facts
Riskowski J, Dufour AB, & Hannan MT (2011). Arthritis, Foot Pain & Shoe Wear: Current Musculoskeletal Research on Feet. Curr Opin Rheum, 23(2), 148-155.

Siddiq MAB, Hasan SZ, Das G, & Khan AUA (2011). Interventional Pain Management in Rheumatological Diseases – A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh. Kor J Pain, 24(4), 205-215.

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