Foot Pain

Foot Pain 2018-05-23T15:20:35+00:00

What Is Foot Pain?

Your feet are a vital component of your every day functioning and movement. For those who suffer from foot pain, it can have immediate and long-lasting effects on your daily activities, work, and exercise.

Pain in the feet may have many underlying causes. The most common include:

The foot is made up of many structures and tissues, such as muscles, bone, tendons, and joints, any of which may be a source of pain. It can also be related to ankle pain. Movement or walking may result in the onset of foot pain. This may lead to a lack of mobility and take away from your ability to take part in the activities of normal daily life over time.

Foot Pain Causes

Many cases of foot pain can be traced to the sensory nerves that serve our extremities. These are mainly lumbar or sacral nerves. Damage or inflammation of the nerves of the foot is perceived in the mind as pain. Other foot pain causes can be traced by to an injury, repetitive motion that leads to overuse, or trauma.

The most common foot pain causes include:

  • Age-related wear and tear
  • Bunions, calluses, warts, or blisters
  • Trauma
  • Injury
  • Overuse conditions
  • Arthritis
  • Plantar fasciitis
  • Bursitis
  • Tendinitis
  • Tarsal tunnel syndrome
  • Hammer toe
  • Gout
  • Diabetic peripheral neuropathy (a condition related to diabetes)
  • Complex regional pain syndrome

You can learn about more causes at the Mayo Clinic’s website.

Where you feel your pain and how can help point to the cause of your pain. For example, complex regional pain syndrome is a condition in which you experience pain in the foot, along with other symptoms such as chronic pain, reduced motion, and sensory deficits. Some tumors, or treatments that reduce their size (i.e. chemotherapy or radiotherapy), may cause mechanical damage to the nerves serving a foot, leading to chronic pain. Failed back surgery syndrome is a condition in which nerves are inadvertently damaged in the course of spinal surgery and can result in pain in a lower extremity.

Foot pain may also be caused by direct damage or injury. This may occur during occupational hazards such as prolonged standing or from wearing ill-fitting, tight, or high-heeled shoes. Wear and tear from strength or endurance training may also be a source of damage to the feet. In addition, patients with genetic disorders such as Charcot-Marie-Tooth syndrome develop deformities of the foot that may cause pain. Conditions associated with the release of excessive inflammation, such as rheumatoid arthritis, may also result in foot pain.

Foot Pain Treatments

For many, foot pain will resolve on its own in just a few weeks. If you’re experiencing achy pain after a workout or swelling after a long day on your feet, you can:

  • Perform gentle stretches with your feet and a strap
  • Ice the sore areas
  • Rest your feet for a few days
  • Elevate your feet once or twice during the day
  • Apply lotions, like Tiger Balm or Icy Hot, to the affected areas
  • Taking non-steroidal anti-inflammatories to manage pain

If your pain doesn’t resolve after a few days of rest and treatment, it’s important that you get a diagnosis for your pain. If you believe your foot was injured, go to a doctor immediately. They can suggest the best treatment approach that encourages healing and gets you back on your feet as soon as possible. Let’s discuss some of the most common foot pain treatments.

Physical therapy 

Physical therapy can be incredibly beneficial for patients with foot pain. It’s often the first step for musculoskeletal pain and some types of injuries. This treatment may also improve other symptoms such as:

  • Reduced mobility
  • Joint stiffness
  • Tendonitis

Physical therapy typically involves a program of exercises, stretches, and muscle conditioning with a trained specialist. This treatment may be useful for patients in need of rehabilitation after an injury, and has been shown to reduce pain while restoring the normal function of the limb.

Medications

As noted, non-steroidal anti-inflammatory drugs, such as naproxen or aspirin, can manage acute pain. These drugs inhibit inflammation the body and can offer some some relief in cases of arthritis or injury. Talk to your doctor about the proper dosage and length of use for these.

If these medications don’t work, or if you’re suffering from long-term pain, your doctor can recommend other options. Oral steroids for example can also inhibit inflammation. These, however, are associated with side effects such as:

  • Changes in bodyweight
  • Increased irritation or other emotional problems
  • Gastrointestinal disorders
  • Organ damage
  • The probability of these side effects increase with regular intake over time. Because of this, these are generally recommended only after other treatment options have failed or for short-term use.

Foot pain injections

Interventional treatments can help manage moderate to severe foot pain. However, only attempt these treatments after other options have failed. More often, these are best to use in conjunction with other therapies. For example, injections can allow you time to undergo physical therapy that corrects the underlying cause of your pain.

The lumbar or sacral nerves serving the feet can be temporarily numbed to inhibit moderate to severe foot pain. To do this, your doctor will inject a local anesthetic (e.g. bupivacaine) into the vicinity of these nerves. These injections, known as nerve blocks, may also contain steroid medications that reduce inflammation if present. Nerve blocks are effective, but may result in adverse events such as chest numbness and headache. Other rarer side effects include the loss of motor control or sensation. Always work with a highly-experienced pain specialist to avoid these risks.

Steroids (often in combination with local anesthetics) may be injected directly into a joint (i.e. the ankle) that is the source of chronic pain. These joint injections are common treatments for patients with arthritis who experience moderate to severe pain. They may result in short- to medium-term pain relief, and may need to be repeated regularly for maximal effects. The side effects of these procedures are similar to those for oral steroids, and may also include short-term immunosuppression.

Radiofrequency ablation

Radiofrequency ablation is a more long-term method of nerve blocking. In this procedure, the painful nerve is located using imaging techniques. A thin probe is inserted (under local anesthetic) until it reaches the nerve. The probe will then deliver radiofrequency impulses, disrupting specific areas of the nerve associated with pain signaling.

The risks of radiofrequency ablation include the small probability that the probe will also inadvertently disrupt other parts of the nerve that control sensation. Other risks include bleeding and infection in the tissues through which the probe was inserted, discomfort, and the failure to achieve pain relief. However, radiofrequency ablation may result in a number of months’ worth of pain relief. This can allow you to undergo physical therapy to correct the underlying cause of your pain.

You can learn more about this treatment in the following video.

Surgery

Surgery is a treatment approach that you should only attempt after reviewing all of your other options. It may be necessary for traumatic injuries, followed by physical therapy.

Another long-term option for chronic, treatment-resistant foot pain may be spinal cord stimulation of the affected nerves. This is a minimally-invasive procedure that involves the implantation of a small device near the spinal cord. This implant interrupts pain signals by emitting electrical impulses. The risks of spinal cord stimulation include:

  • The accumulation of scar tissue near nerves, which may in turn lead to chronic pain
  • Movement of the implant away from its proper location
  • Failure to elicit the desired effect

Spinal cord stimulation is safe and effective in the vast majority of patients treated, however.

Conclusion

Foot pain may profoundly affect your normal function and movement. It may be associated with a wide range of factors, including conditions like arthritis, injury, mechanical damage, and nerve damage.

As foot pain is processed by sacral or lumbar nerves, many treatments for this type of pain may target them directly. To find out more about the best treatment options for you, talk to a pain specialist. They’ll first diagnose the cause of your pain, and then discuss treatments that could work.

You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.

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References

  1. Draovitch P, Edelstein J, Kelly BT. The layer concept: utilization in determining the pain generators, pathology and how structure determines treatment. Current reviews in musculoskeletal medicine. Mar 2012;5(1):1-8.
  2. Irving DB, Cook JL, Young MA, Menz HB. Impact of chronic plantar heel pain on health-related quality of life. Journal of the American Podiatric Medical Association. Jul-Aug 2008;98(4):283-289.
  3. Ives, T.J..; et al. (2006) Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Services Research. Vol. 6 (46) 1-10.
  4. Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain physician. Apr 2013;16(2 Suppl):S49-283.
  5. McAuley J, Aydin Y, Green C, van Groningen R. Patients’ experiences with spinal cord stimulation for lumbar spondylotic pain: comfort at the implantable programmable generator site. Journal of neurology, neurosurgery, and psychiatry. Nov 2013;84(11):e2.
  6. Meier PM, Zurakowski D, Berde CB, Sethna NF. Lumbar sympathetic blockade in children with complex regional pain syndromes: a double blind placebo-controlled crossover trial. Aug 2009;111(2):372-380.
  7. Nagda JV, Davis CW, Bajwa ZH, Simopoulos TT. Retrospective review of the efficacy and safety of repeated pulsed and continuous radiofrequency lesioning of the dorsal root ganglion/segmental nerve for lumbar radicular pain. Pain physician. Jul-Aug 2011;14(4):371-376.
  8. Rigoard P, Desai MJ, North RB, et al. Spinal cord stimulation for predominant low back pain in failed back surgery syndrome: study protocol for an international multicenter randomized controlled trial (PROMISE study). Nov 7 2013;14(1):376.
  9. Rodriguez CG, Lyras L, Gayoso LO, et al. Cancer-related neuropathic pain in out-patient oncology clinics: a European survey. BMC palliative care. Nov 7 2013;12(1):41.

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