Foot pain
Definition
The foot comprises 26 bones, which connect to form several joints, held together by numerous elastic muscles and strong ligaments. It bears the total weight of the human body, so foot pain not only causes discomfort but, in many cases, limits movement.
Foot pain is a common symptom that can be caused by various reasons. In some cases, when collecting anamnesis, the doctor needs only such characteristics of foot pain as its localization and conditions of origin, as well as the presence of concomitant diseases and other symptoms that accompany this pain (numbness of the foot, itching of the skin, etc.). In others, searching for the cause of pain requires a thorough laboratory and instrumental examination.
Types of foot pain
In terms of duration, following types are distinguished:
- Sharp pain in the foot is most often associated with injuries: broken bones, torn or sprained ligaments, or severe bruising.
- Chronic pain bothers the patient for a long time. In some cases, in the absence of proper treatment, a person forms a forced type of gait, which is associated with attempts to preserve the function of movement while sparing the affected limb. The causes of this condition can be diseases of the foot itself and pathologies of various body systems.
According to localization:
- Diffuse pain – takes over the entire foot.
- Localized pain – clearly limited to a specific area.
Possible causes of foot pain
One of the main causes of pain is traumatic foot injuries (bruises, sprains, bone fractures). In fractures, the pain is sharp, and there is a rapid increase in swelling. In many cases, the supporting function of the foot is lost. Contusions and sprains are characterized by moderate pain, swelling, and hematomas. Support is preserved, sometimes limited.
The next cause is inflammatory processes affecting the joints of the foot. These include gout, chondrocalcinosis (pseudogout), rheumatoid arthritis.
Gout is a disease resulting from a disorder of uric acid metabolism. Deposition of uric acid salts in the joints is called gouty arthritis. In this disease, the first metatarsophalangeal joint is most often affected, manifested by a severe attack of pain, redness of this joint, swelling, and fever. Usually, an exacerbation of gouty arthritis lasts 6-7 days.
Rheumatoid arthritis is a systemic disease that also affects the joints of the feet and hands. It is characterized by morning stiffness and pain in the hands and feet.
Pain in the foot can be a symptom of bone pathology. In this case, we can talk about diseases such as osteomyelitis, osteoporosis, bursitis of the head of the metatarsal bone, etc.
Osteomyelitis can result from open fractures, infected wounds, and surgical interventions on the foot. It is manifested by increasing pain and worsening of the general condition. The pain is pulsating, spreading, and intensifying with any movement.
With osteoporosis, the strength of bone tissue is disturbed due to a decrease in bone density. This condition is promotedby hormonal changes in women during menopause and pregnancy, some endocrine diseases, insufficient calcium and phosphorus intake from outside, and excessive loads on the musculoskeletal system.
Pain in the feet in this disease is constant and increases with movement. Bursitis of the metatarsal heads is a change in the articular bags of the foot joints, associated with increased traumatization due to age-related thinning of the fatty layers protecting them. It is manifested by the appearance of painful “bumps” in the projection of the foot joints.
Diseases of the ligamentous apparatus of the foot with pain syndrome include plantar fasciitis, for example. The heel fascia is a plate of connective tissue that starts from the heel bone and ends with attachment to the heads of metatarsal bones. With increased loads, excess weight, and flat feet, the fascia is stretched and traumatized, which causes inflammation in it. This condition is called plantar fasciitis and is manifested by pain in the foot’s instep and on its sides.
A distinctive feature of this disease is also that the pain occurs in the morning, after a night’s rest, increases with exertion, and, in some situations, can lead to lameness.
A heel spur is a condition in which the fascia ossifies at the place of its attachment to the heel bone, causing severe pain in the heel when walking.
Diabetes mellitus—a disease in which the vessels of the microcirculatory channel are also affected due to a violation of glucose metabolism—can cause foot pain. Diabetic osteoarthropathy (a type of diabetic foot) affects mainly the metatarsal-tarsal joints. Foot pain is initially non-intense, but as the pathological process develops, it becomes prolonged, appears even at rest, and forms a gross deformity of the feet.
With the neuropathic form of diabetic foot, zones with hyperkeratosis are formed, and painful ulcers and cracks are formed in their place.
The ischemic form of diabetic foot is characterized by pain when walking, persistent swelling of the feet, and weakening of the pulsation of the arteries.
Diabetic foot with the development of gangrene, along with obliterative atherosclerosis and endarteritis, is one of the most severe complications of diabetes mellitus.
What doctors to see for foot pain
Pain in the foot brings significant discomfort and often makes it difficult to move, so deciding which doctor to see is necessary to avoid long queues and unnecessary trips to the clinic. As a rule, an orthopedist carries out the diagnosis, treatment, and rehabilitation of people with deforming or traumatic lesions of bones, joints, muscles, and ligaments of the musculoskeletal system. However, patients with diabetes mellitus should make an appointment with an endocrinologist and with vascular problems – with an angiologist. Rheumatologists are engaged in treating diseases associated with chronic connective tissue lesions. A traumatologist consults patients with foot injuries. If symptoms resembling those of an ingrown toenail, osteomyelitis, or whitlow appear, a surgeon should be consulted.
In most cases, care can be provided outpatient, but sometimes hospitalization is required.
Diagnosis
The following tests may be necessary to clarify the final diagnosis and determine the cause of your foot pain:
- Single-projection radiography of the feet
X-ray examination of the foot in two projections allows you to diagnose injuries and other pathological changes, including flat feet.
- Lower extremity vascular ultrasound
Ultrasound examination is necessary to monitor the condition of the arteries and veins of the lower extremities and assess the blood supply to the extremities.
- Ultrasound of large joints
Ultrasound examination of the structure of large joints and determination of their functional activity.
Treatment
Bursitis of the heads of metatarsal bones, rheumatoid arthritis, and pain syndrome can be relieved by topical agents and intra-articular injections of analgesic anti-inflammatory drugs. Drugs that reduce the concentration of uric acid are prescribed to correct purine metabolism in gout. The selection of dosage and drug is carried out exclusively by a specialist.
Therapy for diabetes mellitus is complex, and the main task is maintaining glucose levels within the norm.
Whitlow and ingrown toenails are often corrected with simple surgical manipulations in outpatient settings.
In some cases, surgical treatments such as electrical stimulation of the spinal cord or spinal ganglion may effectively relieve pain.
All these treatment options are available in more than 90 hospitals worldwide (https://doctor.global/results/diseases/foot-pain). For example, Spinal cord stimulation (SCS) can be performed in these countries at following prices:
Germany$8.3 K in 8 clinics
United States$58.2 K – 77.6 K in 3 clinics
Israel – by request in 1 clinic.
