Foot Pain
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| 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.
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[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.
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[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.
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[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.
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References:
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 5.
2. The Merck Manual, 7th 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, 7th 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
