Foot Pain

From WebHealth

Common reasons for foot pain Introduction
Diagnosis:	Comments:
Bunion	often caused from high heels in women, a deformity of the great toe metatarsophalangeal joint
Effects of diabetes on the feet	causes foot ulcers and joint problems
Flatfoot (pes planovalgus)	structural collapse of medial longitudinal foot arch
Gout	tophi (=uric acid deposits) over joints of great toe
Morton's neuroma	benign tumor of interdigital nerve at base of toe
Nerve root compression	foot pain caused by compression of nerve root (from disc herniation)
Osteoarthritis of the foot	can affect the joints between hindfoot bones and the MTP or the interphalangeal joints
Osteochondritis (Freiberg's and Köhler's disease)	Freiberg's: avascular necrosis of second metatarsal bone, mostly in females during puberty; Köhler's:avascular necrosis of navicular bone in foot on one side of young boys
Plantar fasciitis	common with ankylosing spondylitis
Rheumatoid arthritis of the foot	destructive arthritis of joints in feet with deformities
Sesamoid bone pathology	variations of small bony inclusion of flexor tendons can cause annoying foot pain
Stress fracture	overuse (marching) can cause it, but also osteoporosis
Tarsal tunnel nerve compression	burning feeling on sole of foot from compression of medial plantar nerve (needs release)
Return to top of table

[edit] Introduction

Foot pain is a common complaint. It is due to a variety of conditions as listed in the table above. Each one of these conditions can make it very difficult to walk for the person who has it and cause limping. It is important that the physician or podiatrist examines the foot carefully and identifies the problem correctly so that a rational therapy can solve the patient's problem.

In the following I will describe the conditions mentioned above (modified from Ref.1), the diagnostic tests that can be utilized to diagnose them and the therapeutic treatment modalities that are usually followed regarding these conditons.

Home page

Arthritis

Foot pain

[edit] Stress fracture

Patients who do a lot of running or patients whose bones are osteoporotic, like post menopausal women without hormone supplementation, can develop little cracks in the bones of the metatarsal shafts, called stress fractures. The arrow in this X-ray point out a metatarsal stress fracture of the first metatarsal bone. This leads to a painful forefoot and a bone scan would show the stress fractures right away. later on (after about 2 to 4 weeks) when callus bone formation happens during the bony repair, plain X-rays will also show these fracture lines. Treatment is done by rest, some padding such as with an air cast and avoidance of strenuous exercises until complete healing has been achieved. In the case of osteoporosis this condition has to be treated accordingly as indicated elsewhere under this link.

Home page

Arthritis

Foot pain

[edit] Gout

Often gout starts to declare itself by leading to a painful swollen big toe or an acute gouty first metatarsophalangeal (MP) joint at the base of the big toe. This is so because the circulation is poor in the lower expremity and the uric acid crystals precipitate easiest into the connective tissue at these locations under these circumstances. I refer to this link to the gout chapter for the diagnostic tests and treatment. It is important to treat gout appropriately right away in order to avoid crippling foot deformities.

Home page

Arthritis

Foot pain

[edit] Nerve root compression

A disc herniation can also lead to pain in the foot by way of referred pain. Usually there are other associated symptoms such as lower back pain, pain and muscle weakness in the leg and numbness in the sole of the foot. This scenario occurs with compression of the S1 nerve root in the case of an L5/S1 disc herniation. This image shows two disc herniations, one at L4/5 and one at L5/S1 (marked with "C"). When a drop foot develops due to extreme muscle weakness from the S1 nerve root comression, a neurosurgeon or orthopedic surgeon with back surgery experience needs to be consulted to posssibly have a discectomy done. Prior to that a CT scan or MRI scan is needed to confirm the clinical diagnosis. Following the surgery early reactivation is needed to return the patient to normal function as soon as possible.

Home page

Arthritis

Foot pain

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 5.

2. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.

3. Wheeless' Textbook of Orthopaedics: http://www.wheelessonline.com/

4. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 60, p.487.

5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

6. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

7. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier