by Lisa Pavese, FNP, Paul Lynch, MD, and McJunkin, MD.
Foot pain is a very common affliction. The human foot is comprised of 26 bones and 33 joints.
In addition, there are also hundreds of ligaments, muscles and nerves. Some of the common causes of foot pain include bone spurs, stress fractures, Achilles tendinitis, bursitis, neuropathy, osteoarthritis, neuromas, and tarsal tunnel. The causes of foot pain can be divided into two categories, structural, or neuropathic.
Structural Foot Pain
There are many different structures of the foot, and thus, multiple abnormalities that can occur. Some common structural abnormalities include bone spurs, Achilles tendinitis, osteoarthritis, rheumatoid arthritis, and stress fractures.
Bone spurs, or osteophytes, are bony projections that can develop along the edges of the bones in the feet. Bone spurs, which are typically the result of arthritis, can be very irritating to surrounding nerves, and cause a significant amount of pain.
Achilles tendinitis is an inflammation of the Achilles tendon, located just above the heel. Achilles tendinitis is usually the result of participation in sports that utilize the ankles and calf muscles significantly, such as running, dancing, and playing basketball.
Osteoarthritis is caused by the breakdown and eventual loss of cartilage in the joints, and typically occurs in older individuals.
Rheumatoid arthritis is a disorder in which the body’s immune system attacks normal joint tissues, resulting in severe pain and deformities. Stress fractures are tiny fractures that can occur in the bones of the feet, and are typically caused by overuse, or improper physical training.
Some treatments for structural foot pain include:
- Non-steroidal anti-inflammatories (NSAIDS)
- Opioid medications
- Physical therapy
- Steroid injections
- Surgical intervention
- Neuropathic Foot Pain
Foot pain can also be neuropathic. Common neuropathic causes for foot pain include Morton’s neuroma, peripheral neropathy, RSD, and lumbar radiculitis.
A Morton’s neuroma is swelling and irritation surrounding a nerve, typically centered between the third and fourth toes. Peripheral neuropathy is an inflammation of the peripheral nerves in the lower extremities, and can stem from multiple things including Diabetes Mellitus, infections, and vitamin deficiencies.
RSD is an abnormal neuropathic response, usually caused by an injury to the foot, and is characterized by redness, swelling, and temperature changes. Foot pain can also be caused by nerve root impingement at the lumbar spinal level. Some treatments for neuropathic foot pain include:
- Medications like Lyrica (pregabalin), Neurontin (gabapentin) and Cymbalta (duloxetine)
- Lumbar epidural steroid injections
- Lumbar sympathetic blockade
- Physical therapy
- Neuromodulation via TENS unit or spinal cord stimulation
Spinal Cord Stimulation (SCS) is often described as a “pacemaker for pain” and uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of chronic pain impulses. Under a local anesthetic and minimal sedation your doctor will first place the trial SCS leads into the epidural space. The SCS lead is a soft, thin wire with electrical leads on its tip and is placed through a needle in the back into the epidural space.
The trial stimulator is typically worn for 5-7 days as the lead is taped to your back and connected to a stimulating device. If the trial successfully relieves your pain you can decide to undergo a permanent SCS if desired. With both neuropathic and structural foot pain, the utilization of multiple treatment modalities increases the likelihood of improvement in patients’ pain and quality of life.
At Arizona Pain Specialists, we provide a comprehensive, multidisciplinary approach to dealing with your pain. If you suffer from chronic foot pain, call us today to schedule an appointment!
American College of Foot and Ankle Surgeons (2008). Foot and Ankle Information. Retrieved December 11, 2009 from: http://www.footphysicians.com/footankleinfo/ Malanga, Gerard. (2009). Emedicine: Lumbosacral Radiculopathy. Retrieved December 11, 2009 from: http://emedicine.medscape.com/article/95025-overview Mayo Clinic (2009). Peripheral Neuropathy. Retrieved December 11, 2009 from: http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131/DSECTION=causes Mayo Clinic (2008). Foot Pain. Retrieved December 11, 2009 from: http://www.mayoclinic.com/health/foot-pain/MY00082/DSECTION=causes National Institute of Health (2009). Foot Pain. Retrieved December 11, 2009 from: http://www.nlm.nih.gov/medlineplus/ency/article/003183.htm