It is important to resolve foot pain as quickly as possible. The longer a painful foot is left untreated, the more likely the problem will worsen. This can have a huge negative effect on general mobility, as has been shown in those with musculoskeletal foot pain. Difficulty in walking has also been shown to exacerbate other health problems and can lead to an increase in overall morbidity. Those who have developed a limp to compensate for pain often sustain injuries in other areas of the body.
There are many causes of foot pain. Some of the mechanical causes are from poor, faulty, or inefficient function of the bones, ligaments, tendons, or muscles that make up the foot. This has been termed musculoskeletal foot pain and is a very common problem. High levels of impact and torsion can cause an acute injury to areas of the foot, and these injuries are more common in certain environments. Dropping a heavy object on the foot can cause an acute trauma and should be dealt with as soon as possible, and injuries during sport due to hard or awkward landings are fairly common. The foot can also succumb to the same sort of overuse injuries. An example of this type of injury is a stress fracture, which can occur in the bones of the foot after abnormal and prolonged stress. The injury is not as severe as acute trauma, and often people will continue to exercise despite the pain, although this is not recommended. This can also lead to developing chronic conditions. Some progressive and systemic diseases can also have a substantial effect on the feet, altering their structure and function and causing pain. An example of this is rheumatoid arthritis. Other diseases can cause localized damage to the foot, such as peripheral vascular disease, which can cause skin ulceration. Diabetic patients will often suffer from foot pain and foot problems.
Foot pain is a common problem among adults and may occasionally occur in children. Foot pain will continue to worsen over time if not dealt with properly. Such deterioration can be so extreme that it may impair normal and essential activities, requiring the need to resolve the problem quickly.
Definition of Foot Pain
Foot pain and problems can be acute or chronic. Acute pain comes on suddenly and can be from a traumatic event like an injury or something more serious like a tear or rupture of a tendon. This sometimes, but not always, requires an immediate diagnosis and treatment to rule out a fracture which can be done at a hospital with an x-ray. A sudden acute pain can also be from an exacerbation of a chronic problem. An example of this would be a gout attack in someone who has gout. Gout is a form of arthritis which can cause inflammation in a joint due to a crystal build up. Chronic pain is classified as pain that has been present for more than three months. This is the point where people become more desperate to get rid of their pain because it is around this time that people start to become more affected in their normal daily activities and quality of life.
I have seen patients who have a very sore spot on their foot and as a result they change the way they walk to avoid putting pressure on that area. This is usually successful in the short time but ends up causing a problem in another part of the foot and sometimes both feet. It can also be successful in the short term by dulling the pain with alcohol or drugs but this is definitely not something that I would recommend. Alcohol and drug abuse is not only addictive and harmful to your health but it can worsen any foot problem you have because it can cause poor decision making on what the best option for treatment is. Another common story is someone who has a gradual increase in pain and ignores it for a long time before deciding to do something about it. This is usually more difficult to treat because the longer you have a problem, the longer it typically takes to fix it. These patients can be frustrated because for a while they may actually have more pain than when they initially started seeking treatment.
When you suffer from a foot problem which results in pain, it can be a very frustrating and sometimes debilitating experience. These problems can occur in any of the foot structures including the toes, the bones, the tendons, the ligaments or the muscles. Because of the biomechanics of the foot, there are many different areas where problems can occur. The most common symptoms are pain and inflammation. Those two symptoms can occur in the same area because of the compensation of the biomechanics of the foot.
Importance of Addressing Foot Pain
If you are suffering from foot pain, it is advantageous to visit a doctor who specializes in podiatric medicine. A podiatrist will be able to identify the cause of the foot pain. This in itself provides relief because just knowing what the problem is brings some of the fear down. The next steps of treatment may be in the form of physical treatment. This may be by taping and padding the foot to give it support, or by the use of orthotic therapy. Lifestyle changes to allow for an improvement of the foot problem may also be the first step in treatment. This can be as simple as changing footwear or more complex by improving biomechanics (walking cycle) of the patient through specific exercises. In more severe cases, usually with chronic foot pain, a surgical procedure may be the best option. This may be minor surgery or a procedure to correct a bigger problem. The knowledge that there are many options of treatment for the foot pain is positive in itself. This is because many other health problems today have limited options of treatment or no treatment at all. The foot is a very resilient body part, and given the right care, treatment, and assessment, it is quite possible to improve or rectify the problem. A fully functional pain-free foot has many positive implications for the patient.
Foot pain is an extremely common problem, and often it can be incapacitating. The problem can be localized to a specific area of the foot, but it may also spread to the entire foot. It may or may not be associated with any trauma or injury to the foot. It may be acute or chronic. It has many effects.
Common Causes of Foot Pain
Medical conditions Medical conditions such as osteoarthritis, gout, or an infection can also cause foot pain. The symptoms of these conditions are varied and often complex. Normally, there will be pain, discomfort, and swelling at the affected part of the foot. Osteoarthritis often affects the big toe joint, gout often affects the joint at the base of the big toe, whilst an infection can cause pain in any part of the foot. Symptoms of systemic diseases (diseases affecting many parts of the body) can often manifest in the feet. It is important to be aware of the possibility of these conditions, but professionals such as rheumatologists or podiatrists will usually need to make a diagnosis. So, if you suspect one of these conditions, seek medical advice.
Foot injuries Injuries such as ligament sprains and muscle strains are common, especially if you participate in sports. Usually, the signs are pain, often sharp and sudden, depending on the severity of the injury, and swelling. Sometimes there may be difficulty walking or standing on the affected foot. Tenderness and discomfort are usually at the site of injury. If pain or discomfort persists, seek medical advice. The injury may be more serious than originally thought. Other injuries such as bruises, cuts, or abrasions are usually minor and can be self-treated. A more serious injury is a torn or ruptured tendon. This can occur in a fall or sudden twist of the foot. Symptoms are usually pain and instability of the affected area of the foot. It is important to consult a doctor if you suspect a torn or ruptured tendon. Often surgical repair is needed.
Some of the common injuries with similar symptoms are: – Stress fractures: Often a condition which is difficult to detect and difficult to be sure of the best form of treatment. Often stress fractures are recurring. – Achilles tendonitis and rupture: Pain at the back of the heel or in the calf, and swelling, discomfort, and sometimes a gap at the site of the rupture. – Plantar fasciitis: This is inflammation of a thick band of tissue that runs across the bottom of your foot, from the beginning of your heel to your toes. This condition is known to cause the most heel pain, often being a sharp pain on the inside part of the heel, mostly experienced in the morning and gradually reducing in the day. – Strains to various muscles and ligaments
Overuse and strain Overuse and strain injuries are one of the most common types of injuries that are seen in athletes, particularly in running sports. Typically, the warning signs are pain after activity or in the morning, or swelling and tenderness in a joint. There are specific types of injury associated with particular sports. For example, swimmers may get pain in the sole of the foot because of pressure from the side of the pool, ski boot, or ice skate. Sports such as tennis, basketball, and field sports may be related to more diverse types of injuries.
Overuse and Strain
The best treatment is to identify the cause and decrease the level of activity which is causing the problem. Icing the area and taking an anti-inflammatory are a good way to reduce the pain and swelling in the area. However, remember that anti-inflammatories can affect the stomach, kidneys, and blood pressure. Obviously, if they take it to the max level of rest by using crutches or a stick and a period of time off work may be required. Be sure to seek professional advice from a health professional. If the problem is being caused by poor biomechanics, a podiatrist is likely to be able to fix the problem with a device such as a foot orthotic. Physiotherapy can also be a potent form of treatment, with the application of various modalities and an exercise regime to fix the problem.
This happens when you subject your foot to more activity than it is accustomed to. One of the most common examples of people doing this is taking up a new form of exercise, such as jogging or hill walking. You may also overuse the one part of the foot because of poor biomechanics or footwear. Working on the feet for long hours is also a common cause. All of these activities can lead to small microtrauma in the muscles and tendons, which can be difficult to rest and heal because we still have to walk on it. This results in chronic foot or leg pain. In severe cases, the muscle or tendon may even rupture with a sudden severe pain, accompanied by swelling in the area and an inability to walk.
Foot Injuries
A sudden (acute) injury may occur from a direct blow, a penetrating injury, or from a twisting or a crushing injury. Acute injuries include bruises, injuries to ligaments (which can result in sprains), and injuries to muscles and tendons (which can result in strains). Although a forceful injury is the most likely way to damage a bone or move a joint out of place, some high energy injuries, such as a stress fracture, can occur with no recollection of a specific injury. High heels, for example, increase the weight on the forefoot and can result in a stress fracture. An injury may also occur from an abnormal twisting of the foot, such as an ankle sprain. This is a common injury and often occurs when people are participating in sports. An ankle sprain is a stretch and/or tear of a ligament, and damage to surrounding tissues. This often occurs when the foot rolls inwards.
There are many different injuries that can cause foot pain. People who often take part in physical activity are at a greater risk of developing foot pain from an injury. The injury may be the result of one incident, such as a broken bone, but more often is the result of the cumulative effect of repetitive microtrauma. This is often the case with stress fractures and tendonitis. Less obvious gait abnormalities caused by muscle weakness or joint stiffness can result in an abnormal distribution of weight on the foot and lead to an overuse injury.
Medical Conditions
Obesity has been linked to increased prevalence of foot pain. A study by King et al. showed that overweight subjects were at a 1.6 times greater risk for foot pain compared to normal weight subjects. In the overweight group, for every 1kg increase in weight, there was a 1.14 times increase in risk for foot pain. The location of pain was also associated with specific areas of the foot, increased weight on the medial part of the foot had a strong association with pain on the inside of the ankle and foot. Excessive weight can alter the biomechanics of the foot through added stress on the joints and supporting structures of the medial longitudinal arch.
Gout is a form of arthritis that often affects the feet causing acute pain. The big toe is the most common area to be affected but it is possible for other areas of the foot to be inflamed. Symptoms usually arise suddenly and can be severe, with the pain typically subsiding after a few days. Persistent discomfort can cause damage to joints and surrounding tissue. Treatment is focused on controlling pain and preventing future attacks. Therapy of acute attacks includes anti-inflammatory drugs NSAIDs, corticosteroids, and colchicine. Lifetime management to control the balance of uric acid is done with change in diet and possibly medication.
Certain medical conditions can cause chronic foot pain and may require specialty treatment. Having diabetes, arthritis, or cardiovascular diseases increases the risk of developing pain in the feet. Diabetes requires professional treatment and medical recommendations on alleviating the pain. If the pain is due to nerve damage, sometimes called neuropathy, the individual may not be able to sense pain due to complications with poor circulation. It is advised to take pressure off the inflicted area as much as possible as this allows blood to flow to the area, aiding in the healing process.
Treatment Options for Foot Pain
Using the least amount of medication to control foot pain is the best approach due to the potential side effects and risks of long-term use of pain-relieving medications. However, sometimes the pain is severe enough or an inflammatory condition is acute enough to warrant the use of oral steroids or a short course of nonsteroidal anti-inflammatory medication. Caution is to be used with chronic use of NSAIDs as there can be substantial adverse effects on the stomach, kidneys, and cardiovascular system. Cortisone injections given by a foot and ankle specialist are a treatment option for severe inflammatory conditions such as rheumatoid arthritis or gout. Cortisone injections can provide substantial pain relief; however, there is a risk of weakening a tendon or causing a cartilage injury. A newer treatment called hyaluronan injections has been used for painful osteoarthritis. This is a series of 3-5 weekly injections which can provide pain relief for several months by supplementing the viscous synovial fluid in the arthritic joint.
When the pain is chronic or is due to an underlying inflammatory condition, one of the most effective treatments is physical therapy. A physical therapist can help determine the cause of the pain and develop a plan for correction. This may include a gait analysis and correction with the use of an orthotic device, flexibility and strengthening exercises, or modalities such as ultrasound or extracorporeal shock wave therapy. The use of physical therapy has increased substantially in recent years, with healthcare practitioners seeking conservative treatment options over surgery and long-term pharmacological management.
The most important consideration when contemplating treatment for foot pain is determining the precise cause of the pain. As mentioned above, there are many underlying diseases that can cause foot pain, so it is always best to have foot pain assessed by a doctor. Self-care at home is often appropriate, provided it is not a severe injury or the pain is not due to a severe inflammatory condition. The most common self-care treatment for foot pain is rest. Avoiding activities that aggravate the pain or prolonged standing/walking can be very helpful. Icing the painful area (20 minutes every hour), especially when the pain is due to an acute injury, is often very effective at reducing inflammation and pain. Using an over-the-counter nonsteroidal anti-inflammatory medication can also be a helpful adjunct to reduce inflammation. Elevation of the foot is also recommended to decrease swelling when the pain is due to an acute injury.
Rest and Self-Care
Rest is often the key to recovery from common overuse injuries. In the acute phase, patients may be advised to rest the affected foot. This can be done by reducing the amount of time spent on feet, alternating periods of rest with activities, and elevating the foot on a chair or couch. Sleep is very important in the recovery process. Side lying positions can put the least stress on the foot. It is not advisable to sleep with a pillow under or over the affected foot as this could hinder circulation and delay healing. Ice can be applied for 15-20 minute periods every few hours. This can be done using an ice pack or a bucket/bowl of water. Whilst healthcare professionals will offer their advice and guidance, the responsibility of rest lies with the patient. This can sometimes be seen as a ‘hassle’ but completely resting an injury now is less time-consuming than trying to cope with a chronic problem later down the line. Self-care covers a broad spectrum of actions in which a person can undertake in order to look after their own health. In the context of foot pain, this ranges from the very specific (appointment making and adhering to medication regimens) to general healthy lifestyle changes. For example, losing weight to reduce loading forces through the foot. Self-care is becoming an increasingly utilized ‘treatment’ in many western countries as patients look to take control of their own health rather than solely relying on healthcare provision.
Physical Therapy and Exercises
Proximal strengthening exercises for the tibialis posterior and intrinsic muscle groups can be prescribed to help enhance stability about the foot and initiate a more normalized walking pattern. This can be achieved by means of towel curls and big toe raise exercises. Toe curls can be completed with or without a resistive force, aiming to grip and contract the toes around the towel by pulling it inwards towards the foot. The exercise is a dynamic form of the short foot exercise and is progressed by completing on one leg, then onto a step, and eventually toe curling with free weights.
Static stretching exercises should be held for 30 seconds and repeated twice, and can, if tolerated, be progressed over time by increasing the duration of the stretch. Dynamic stretching should be done up to the point of feeling resistance or onset of pain, and should be repeated 10 completes each way. This exercise is used to initiate inflammation repair process to the plantar fascia by increasing the cross-link formation, usually done by slow walking or a slow pain-free jog, with the exercise lasting up to 15 minutes.
Once the sedularity is made rest in the long run, take achieve in lesser misery by means of limiting functional potential somewhat chiefs to gaining weight with immobility and deleterious effects pictures of relative rest. This process leads to altered foot alignment and altered tissue loading thresholds, thus perpetuating the mechanical foot pain system. It is absolutely crucial to prescribe a therapeutic strengthening stretching exercise program that is safe to prescribe and safe for the patient to perform. In some instances, this requires a period of treatment directed at other sources of foot pain to make the foot condition good enough to exercise.
Medications and Pain Relief
There are various types of treatments and pain relief in order to help patients who are suffering from foot pains. You should consult with your GP/Doctor in order to determine the correct cause for your foot pain and they will advise the most appropriate treatment for your condition. In some cases, pain and anti-inflammatory medications (NSAIDs) are prescribed, such as ibuprofen, will help to relieve pain and reduce inflammation caused by foot pain. However, you should ask your doctor before taking any medication. Steroid injections given by your doctor are also an option; however, they are usually used to treat severe pain in specific spots or joints caused by either wear and tear or rheumatoid disease. Corticosteroids are powerful anti-inflammatory medications. Let your general practitioner or orthopaedic specialist know if you have diabetes or multiple myeloma before receiving steroid injections. In some cases, alternative medications such as gabapentin may be recommended. This is a medicine which is primarily used for the treatment of epilepsy or neuropathic pain. Neuropathic pain is pain coming from damaged nerves and it differs from pain messages carried along healthy nerves from damaged tissue.
Orthotic Devices and Supportive Footwear
Semi-rigid orthotics provide dynamic balance for the foot and are often used in sporting activities to maximize performance. This orthotic is made up of layers of soft material with a firm reinforcing material. The precise amount of biomechanical control can be specified when the orthotic is manufactured and is suitable for activities that require speed in maneuvering as it is very durable.
Soft orthotics help to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. This type of orthotic device is often beneficial for arthritic patients as it increases mobility and may often prevent further joint damage.
These devices can be rigid, soft, or semi-rigid. Rigid orthotics are often used to control the function of the two major foot joints below the ankle joint. It is usually constructed from a plaster cast or fiberglass mold and is very prescription, matching the foot precisely. This is usually a long-lasting device and is used for serious biomechanical problems and shoes and boots with a firm heel counter and insole depth.
Orthotic devices are often prescribed to correct abnormal foot biomechanics and to reduce or eliminate pain. The word “orthotic” refers to a device applied to the body, which is designed to correct or alleviate a certain condition. Foot orthotics are shoe inserts designed to support, align, prevent, and accommodate foot deformities or improve foot function.
Seeking Professional Help in Singapore
Second (and for the aforementioned reasons), Singaporeans seek professional help from clinics and hospitals offering foot pain treatment. A polyclinic or hospital would be the first choice for a concise diagnosis as it provides the patient with a full range of services including x-rays and laboratory tests. A patient would be more inclined to visit a polyclinic if the cause of the foot pain is not known. Upon receiving a diagnosis and medication, the patient would then seek the relevant specialist for further treatment. A clinic or hospital would also be the choice of individuals seeking surgery, corticosteroid injections, or other forms of medical intervention for foot pain. As an allied health profession, the field of podiatry is still developing in Singapore, and to some extent, there are limitations as to the availability and types of services that a podiatrist or foot specialist can provide.
Firstly, an individual seeks professional help in Singapore from podiatrists and foot specialists. Podiatrists in Singapore typically hold an undergraduate degree in podiatry and conduct their practice in private clinics. Due to the sizable population of diabetics in Singapore, some of these podiatrists have a sub-specialty in diabetic foot care. Generally, if the cause of the foot pain is known (via diagnosis from the family doctor) and it is not an issue related to an injury, fracture, or disorder, the patient would seek the specialist best suited to his/her ailment. However, one should note that these specialists do not prescribe medication, injections, or perform surgeries. They are limited to providing diagnosis and treatment, and if further intervention is required, they would refer the patient to a doctor. Nonetheless, for conservative management of an ailment in which the cause has already been established, or for preventative measures, a podiatrist is the most suitable form of professional help.
Podiatrists and Foot Specialists
When it comes to relieving foot pain causes and treatment, seeking professional help should be one of the first options in mind. Podiatrists and foot specialists are the most qualified healthcare professionals to take care of your feet. They have spent years studying the anatomy of the foot and the variety of problems that can occur. Foot pain is not normal and not something to be ignored. There are a number of different causes for foot pain, many of which can be effectively treated by a podiatrist or foot specialist. Podiatrists are healthcare professionals who have been trained to diagnose and treat specific foot conditions. They are also trained to identify systemic issues which may affect the feet, such as diabetes and arthritis. Podiatrists today have undergone a change in that the newer generation of podiatrists have been trained in surgery and are able to perform surgical procedures to fix an individual’s foot problem. This is especially beneficial as patients with foot pain causes treatment can seek consultation from a podiatrist and if the problem can only be fixed through surgery, these podiatrists will be able to help. Despite the benefits, many people are not sure what a podiatrist specializes in and some do not even know that the term ‘podiatrist’ exists. People should have more awareness of what podiatrists do and the range of problems they can solve. This way, those with foot pain have an alternative way to fix their problem other than heading down the surgery route.
Clinics and Hospitals Offering Foot Pain Treatment
Following the heightening demand for general medical attention and specialized care for foot pain, the number of different medical facilities and clinics that offer services has steadily increased over the past decade. With the exception of foot surgery, which will be discussed separately, most patients with foot pain will seek to first visit their family physician or a general medical clinic. Family physicians, due to the wide range of training in which they are involved, are able to confidently make a differential diagnosis and establish a treatment plan for the vast majority of the causes of foot pain. On the occasion where a family physician is uncertain of the diagnosis, or the treatment is not effective, the patient will likely be referred to a general medical clinic. At these clinics, the patient can expect to receive high quality care and medical screening for systemic conditions which may be contributing to the foot pain. To date there are over 700 licensed family physicians in Singapore and approximately 1300 general medical clinics. With an increasing elderly population, some of whom may have difficulty travelling out of their homes, there are also several companies which offer house-call doctor services where the patient can receive care in the comfort of their own home. During the past 5 years there has also been a noticeable increase in the number of private specialist clinics. The majority of these are run by orthopaedic surgeons, though some have also been set up by rheumatologists or sports medicine specialists. While it would be more common for a patient to be referred to such a specialist by their family physician or a different specialist, some patients may choose to self-refer especially if they have previously been diagnosed with a specific condition and are seeking care from a doctor with more specialized knowledge. At these clinics, the patient can expect to receive a thorough examination of the lower limb as a musculoskeletal unit, and investigations such as x-rays and ultrasound may be performed in the same visit. This is particularly useful and time-efficient as it spares the patient the inconvenience of having to make a separate visit for investigations.