What Is Foot Pain?
Foot pain explained by San Antonio, Austin, Houston, Dallas Texas top pain doctors
Pain in one or both feet is a common feature of life for many people. Recent estimates indicate that over 20% of adults 45 year or older experience this type of pain frequently. Pain may be felt in any part of the foot, from the ankle joint to the toenails. Foot pain may have a number of causes and risk factors. It may adversely affect normal functions and abilities, such as walking, balance, exercise, sustained walking or standing, and general daily life. Foot pain may sometimes be triggered by attempting to walk or move the extremity in question.
Cause Of Foot Pain
Foot pain may be caused by mechanical or biochemical damage to various tissues and structures that make up this body part.
Foot pain may be the result of many conditions and disorders, including:
- Arthritis: A condition in which the cartilage or other tissues within a joint wear down. This may progress to a point at which the bones making up the joint come into direct contact, which may result in chronic pain and restricted mobility. There are many subtypes of this condition, including osteoarthritis and rheumatoid arthritis.
- Complex regional pain syndrome: This disorder is related to nerve damage and dysfunction that results in disproportionately increased pain perception, skin temperature fluctuations, and swelling, which is usually confined to one extremity (i.e. a hand or foot).
- Plantar fasciitis: In this condition, the thick pad of tissue between the bone of the heel and the skin becomes inflamed and may wear away over time.
- Heel spur: In this condition, the heel bone acquires abnormal calcium deposits to the point that it may form a sharpened point or hook. Heel spurs may accompany plantar fasciitis.
- Inherited genetic disorders (e.g. Charcot-Marie-Tooth syndrome): These often increase the risks of foot deformities, which may result in chronic pain or impaired mobility.
Foot pain may also be associated with a number of risk factors. These increase the probability of foot pain, mostly by increasing the mechanical stresses or pressure on its structures.
These risk factors include:
- Prolonged standing, in an occupational capacity or otherwise
- Regular use of tight, loose, high-heeled or poorly designed shoes
- Prolonged athletic activity
- Increased body mass
Many studies conclude that obesity and other causes of increased body size may increase the risk of foot pain. However, there is evidence that this is related to increased amounts of fat tissue, not simply high bodyweight.
Other cases of foot pain may be related to injury or inflammation to main nerves responsible for sensory control of the feet (e.g. lumbar nerves). This may be associated with some specific factors, including damage to the lower spine. Surgical procedures to correct this carry the risk of further accidental nerve damage, leaving chronic pain of a lower extremity as a consequence. Some tumors may cause mechanical or inflammatory damage to these nerves, which is processed as pain in a foot by the brain. Radiotherapy or chemotherapy may also cause long-term damage to this nervous tissue, resulting in chronic pain.
Treatments For Foot Pain
Patients with musculoskeletal foot pain, or pain resulting from arthritis, may be advised to try physical therapy before resorting to medical or clinical treatment. This option often involves a program of targeted stretching, conditioning, and exercises for the affected area. This may restore function, flexibility, and motion in the body part in question, and may relieve pain by relaxing its muscles, joints, and tendons. Physical therapy may benefit patients with plantar fasciitis, heel spur, and complex regional pain syndrome.
If this option fails to deliver adequate pain relief, the patient may try drug therapy. These may include conventional oral medications such as non-steroidal anti-inflammatory drugs. These include ibuprofen and naproxen. These may effectively reduce inflammation, and are common first-line treatments for pain related to injury or arthritis.
Corticosteroids are another class of medications prescribed to reduce inflammation. If a patient finds this treatment ineffective, or if their pain is too severe for these medications to adequately address, opioid therapy may be considered as a next step. Opioids are a category of advanced painkillers, such as oxycodone and morphine. They are capable of accomplishing significant pain relief. However, they are commonly linked to adverse events such as drug tolerance, respiratory distress, lethargy, and unpleasant withdrawal symptoms. Patients taking opioids are often monitored closely by their pain specialist or physician for risks, such as addiction and abuse.
If foot pain is found to be associated with damage to spinal nerves, these nerves may be targeted directly to inhibit pain. A treatment that may achieve this is a nerve block. This procedure involves finding the precise location of the affected nerves using imaging technology. A needle is then inserted until it reaches an appropriate spot near the nerve. Local anesthetics such as lidocaine are delivered through the needle, which numbs the nerve and prevents it from sending pain signals to the brain. Nerve-blocking injections may also contain steroids to control inflammation of the nerve and thus contribute to pain relief.
These anesthetic or steroid injections may also be performed on a painful ankle to address chronic pain and inflammation. This is a type of joint injection, which is a conventional treatment for arthritis patients. These may restore some function and mobility to the joint. Joint injections may be performed at a frequency of a few weeks to a month, depending on the response of the patient to this treatment. Joint injections may cause side effects related to the steroids injected (as above) and may also result in temporary flare-ups of pain immediately after the procedure.
If these treatment options do not result in the pain relief expected, the patient may try other minimally-invasive procedures in a clinic. These include radiofrequency ablation, which is the disruption of the parts of the nerve that conduct pain signals. This procedure begins by locating the nerve and introducing a thin instrument into its vicinity, as with nerve blocks. This instrument then emits thermoelectric energy to selectively disrupt the pain fibers of the nerve. This may result in medium- to long-term relief, but is not permanent, as the nerve can recover all of its functions after this treatment.
Radiofrequency ablation may be associated with adverse effects, such as neurological abnormalities resulting from rare incidences of inaccurate probe placement. Other more common side effects include infection, bleeding, and discomfort in the skin and tissue through which the probe was extended to reach the nerve.
Another minor procedure to treat chronic, treatment-resistant pain is spinal cord stimulation. This involves the implantation of small, thin electrodes in a precise location in the space just outside the spinal cord. These emit electrical impulses that correct abnormally high pain signals transmitted by a spinal nerve. The ideal result of spinal cord stimulation is the alleviation of pain, which can be controlled by the patient at its onset.
Foot pain may significantly affect normal daily life, gait, and walking. It may be associated with conditions such as complex regional pain syndrome or arthritis. Foot pain can be treated by physical therapy or conventional painkillers. Others treatments, such as nerve blocks and spinal cord stimulation, directly target the spinal nerves responsible for chronic foot pain. A discussion about your pain and other symptoms with your pain specialist may lead to the best treatment option for your individual case.
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