When should I seek Medical Treatment for foot Pain?

When should I seek medical treatment for foot pain?

When the pain begins to interfere with your activities of daily living or if you cannot perform your desired activities without pain, you should consider seeking medical attention. Indicators that you should seek medical care are if the area looks deformed, you have loss of function, change of sensation, a large amount of swelling with pain, prolonged change of skin or toenail color, the affected area becomes warmer than the surrounding areas, becomes exquisitely tender to the touch, or is causing you to move differently.

How is foot pain diagnosed?

Proper evaluation and diagnosis of foot pain is essential in planning a treatment. A good general guideline is to compare the injured side to the uninjured side. Injury may present itself as distinguishable lump or gap felt at that location or a "crunchy" feeling on that spot caused by inflammation. The types, causes, and severity (sharp pain versus a dull ache) also are good indicators of the seriousness of the injury.

• Four grades of pain
• During activity
• Before and after, and not affecting performance
• Before, during, and after athletic activity, affecting performance
• Pain so severe that performance is impossible

The doctor will ask you several questions to determine how the problem began. It can be helpful to tell the physician about how and when it started, how it affects you, when it bothers you, what you may or may not have done to make the pain better or worse. If necessary, a thorough physical exam may be conducted to evaluate for any other injuries.

• Feet will be physically and visually examined at rest, with weight- and non-weight-bearing movement by the medical professional.
• The foot and arch will be touched and manipulated and inspected to identify obvious deformities, tender spots, or any differences in the bones of the foot and arch.
• Dr. Raymond A. DiPretoro, Jr. will examine how the muscles of your foot function. These tests may involve holding or moving your foot and ankle against resistance, you may also asked to stand, walk, or even run.
• The nerves in the foot will be tested to make sure no injury has occurred there.
• An X-ray, MRI, or bone scan of the foot and arch may be taken to determine if there are abnormalities of the bone and/or soft tissues.

How can foot Pain be Prevented?

How can foot pain be prevented?

Physicians with sports medicine, physical medicine, or orthopedic backgrounds may also help you choose an appropriate activity. After choosing the sport or activity that you wish to participate in, proper preparation will help minimize the initial aches and pains of that activity. Proper technique in any activity will help you to properly and safely perform your chosen activity and avoid injury. Good coaching can help you develop good biomechanics that can prevent foot pain.To prevent injuries and pain, the following issues should be addressed before starting an exercise routine. Are you in good health? A general physical exam by a physician will help to evaluate your cardiovascular function, the possibility of disease or any other general medical problems that you may have. Before beginning activities, diseases such as gout, diabetes, certain types of arthritis, and neuropathies should be treated.

Shoes and socks appropriate to your activity will also be a deterrent to foot pain. Properly fitting shoes and proper foot hygiene can prevent blisters, ingrown toenails, corns, calluses, bunions, stress fractures, metatarsalgia,Morton's neuroma, mallet toes, and plantar fasciitis. Poorly fitting footwear can make poor biomechanics worse, and properly fitting footwear can help to minimize the effect of bad biomechanics.

A plan for a gradual return to play should be started once the pain is reduced and muscle strength and flexibility are restored. Returning to participation and prevention of foot pain are governed by the same factors as preparing for participation. Foot pain can be caused by doing too much of a particular activity too fast. Ignoring pain can also lead to further problems with the foot. Different types of foot pain can be seen at different times of the season. Typically, blisters, shin splints, and arch injuries are seen at the beginning of the season. Again, to avoid blistering in the future, a generous application of petroleum jelly to the affected area can be helpful.

Stress-related problems are related to the workloads. If the body is not prepared for an increase of workload that is typical early in the season and with "weekend warriors," acute shin splints and tendonitis are very common, in addition to increased muscle soreness.

After one has foot pain, an optimal workout program begins with a physical exam by a physician, followed by a gradual, consistent workout plan. A good example of this type of program is a running program that starts with a good warm-up, such as walking five to 10 minutes, then alternating sets of jogging and walking. An example of such a program would be 20 sets of jogging for two minutes, then walking one minute, with jogging time increased until you can run continuously for 40 minutes. Good surfaces and proper equipment used in your workout will lower the risk of foot pain.

Components of a good exercise program should include core strengthening, muscle strengthening, and flexibility specific to the goals of the workout program or the sport.

If pain is encountered when working out, try decreasing the intensity of the workout. If the pain persists, then you should immediately stop and seek medical advice from your Podiatrist at Advanced Foot & Ankle Center to discover the source of the pain. Pushing through pain often results in injury.

What other symptoms and signs accompany foot pain?

What other symptoms and signs may accompany foot pain?

Pain and point tenderness are the immediate indicators that something is wrong in a specific area. The onset of pain, whether suddenly or over time, is an important indicator of the cause of the problem. The following questions are also important.

• Is there pain with movement of the affected area?
• Is it affected by weight-bearing?
• Does it change your walking motion?

Bones of the foot are joined together by ligaments. A sprain occurs when the ligaments that hold the bones together are overstretched and the fibers tear. Point tenderness and looseness of a joint can be indicators of a sprain.

Injury to the bones of the foot can be caused by a single blow or twist to the arch or also by repetitive trauma that can result in a stress fracture. Fractures are indicated by a focal point of pain that may be exquisitely tender on the bone. There may be a distinguishable lump or gap at the site of the fracture. A rotated toe or forefoot may also be a sign of a fracture or dislocation.

Muscle and tendons move the body tissues around the joints. A strain occurs when a muscle or group of muscles are stressed to the point where there is tearing of the muscle fibers. The muscles and tendons of the foot may be strained by overstretching, overuse, overloading, bruising, or even being lacerated. Weakness in contraction of a joint, difficulty in stabilizing body parts, and pain working against resistance are signs of muscle problems. Swelling, tenderness, loss of function, and discoloration over and around the injury of can be symptoms and signs of a strain.

Bruises (contusions) are most commonly the result of a direct impact injury to the body. A bruise can occur to the foot by a variety of causes, such as having your foot stepped on or by stepping on a rock. Blows to the foot that result in pain, discoloration, swelling, and changes in how you walk may indicate more serious damage such as fractured bone.

Pain and tenderness associated with planter fascia strains are usually felt on the bottom of the foot between the heel and the base of the toes. Plantar fascia pain may be increased or decreased by stretching of the arch. In mild cases of plantar fasciitis, the pain will decrease as the soft tissues of the foot "warm up," however, pain may increase as use of the foot increases. In more severe cases of plantar fasciitis, pain may increase when the arch is stressed. Often the sufferer of plantar fasciitis will feel pain in the morning until the plantar fascia warms up. Foot pain at night may be a sign of plantar fasciitis as well as other possible problems.

A sensation of rubbing or burning on the surface of the foot is usually the first signs of a blister. Itching and burning sensations between the toes or around the foot indicate a skin infection or athlete's foot. Pain and redness at the edge of a toenail are usually the result of an ingrown toenail.

What Causes Foot Pain?

What causes foot pain?

Injuries such as ligament sprains, muscle strains, bruises, and fractures typically occur suddenly (acutely). Sprains, strains, bruises, and fractures may be the result of a single or combination of stresses to the foot. A sprain of the foot or ankle occurs when ligaments that hold the bones together are overstretched and their fibers tear. The looseness of ligaments in the joints of the foot may lead to foot pain.Foot pain may be caused by many different diseases, biomechanical conditions, or injuries. Acute or repeated trauma, disease, or combinations of the problems are the most common causes of foot pain and are commonly seen in sports and workplace environments that require physical activity Trauma is a result of forces outside of the body either directly impacting the body or forcing the body into a position where a single or combination of forces result in damage to the structures of the body. Poor biomechanical alignment may lead to foot pain. Wearing shoes that are too tight or high heels can cause pain around the balls of the feet and the bones in that area. Shoes that are tied too tightly may cause pain and bruising on the top of the foot.

The muscle's bursa and fascia of the foot can be strained by overstretching, overuse, overloading, bruising, or a cut (such as by stepping on a sharp object). Achilles tendonitis is a common injury of the tendon that attaches at the back of the heel.

Injury to the bones and joints of the foot can be caused by a single blow or twist to the foot, or also by repetitive trauma that can result in a stress fracture. A blunt-force injury such as someone stepping on your foot may result not only in a bruise (contusion) injury but also damage to the muscles and ligaments of the foot. Direct blows to the foot can cause bruising, breaking of the skin, or even fracturing of bones. Metarsalgia is the irritation of the joints of the ball of the foot. The term "stone bruise" is commonly referred to as a specific localized pain and tenderness of the bottom of the foot. "Turf toe" is a common athletic injury in which the tendon under the joint at the base of the big toe is strained. Trauma to the toenail can cause pooling of blood under the nail and the temporary or permanent loss of a toenail. Repetitive trauma to the bones, muscles, and ligaments can result in extra bone growth known as spurs or exostoses.

Sprains, injuries to the ligaments of the foot, occur when ligaments are overstretched. The ligaments that attach the foot to the ankle are also commonly sprained.

Injuries to both the skin covering and the internal structures may also be caused by multiple small repetitive traumas. Microtrauma injuries can be caused by running on uneven surfaces or surfaces that are too hard or too soft, or by wearing shoes that have poor force-absorption qualities or fit incorrectly. Thickenings of tissue of the outer foot and toes are commonly known as bunions, corns, and calluses. These are often caused by poor-fitting shoes. Morton's neuroma caused by thickening of tissue around a nerve between the toes can cause toe numbness and pain and may also be aggravated by poor-fitting shoes. Footwear can be a contributor to foot pain. Poor-fitting shoes in the short term can cause blisters, bruising, and be a source of athlete's foot. The long-term effects may be bunions, corns, irritation of nerves and joints, misalignment of the toes, and the source of microtrauma injuries to the foot.

Repeated overstressing of the same structure of the foot may cause stress fractures, tendonitis, plantar fasciitis, and acute and chronic osteoarthritis. Stress fractures commonly occur in the metatarsal bones, the long bones of the foot.

The arches of the feet absorb and return force to and from the body to the outside world when we are standing on our feet. Injury to the plantar fascia is a common cause of arch pain. The plantar fascia is a tough fibrous sheath that extends the length of the bottom of the foot and lends support to the arch. When the plantar fascia is damaged, the resulting inflammatory response may become a source of arch pain. High and low arches (flat feet) may cause pain because of strain to the feet.

Disease, viruses, fungi, and bacteria may also be the sources of foot pain. Diabetes, Hansen's disease, arthritis, and gout are common diseases that affect the foot. Disorders of the nerves to the feet may cause numbness and burning sensation in the feet known as peripheral neuropathy.

Plantar warts on the bottom of the foot are caused by a virus and can cause irritation. Athlete's foot, which is caused by a fungus, also can lead to foot irritation. A common cause of foot pain is the ingrown toenail. Ingrown toenails occur when the edges of the nail grow through or into the skin, resulting in irritation and sometimes leading to infection.

If you are experiencing any of the above, please call our office, Advanced Foot and Ankle Center @ (302) 623-4250 for an appointment!

How is the Foot Designed?

How is the foot designed?

The foot is an intricate structure of 24 bones that form two crossing arches of the foot. The longitudinal arch runs the length of the foot, and the transverse arch runs the width. The ankle joint is formed by the interaction of the foot and the lower leg, and the toes are on the far side of the foot. The bones of the foot are primarily held together by their fit with each other and connected by a fibrous tissue known as ligaments. The muscles of the foot, along with a tough, sinewy tissue known as the plantar fascia, provide secondary support to the foot. The foot has internal muscles that originate and insert in the foot and external muscles that begin in the lower leg and attach in various places on the bones of the foot. There are also fat pads in the foot to help with weight-bearing and absorbing impact.

The foot is the foundation of movement of the lower extremity. Pain in the foot indicates that there is something wrong with either the interaction of internal structures of the foot or with the how the foot is interacting with external influences. How and when the pain occurs and the locations of the pain are the primary clues to what may be causing the pain. When there is pain, the body reacts by changing the way it moves or functions in an effort to reduce the pain. Biomechanical changes or disease may prevent the normal movement and cause further injury.

Arthritis of the Big Toe! ( 1st MPJ)

Arthritis of the 1st Metatarso-phalangeal Joint (Hallux Limitus/Rigidus)

One of the more common symptoms of osteoarthritis in the foot is located to the first metatarso-phalangeal joint (Hallux Limitus/Rigidus). Normally, 90% of body weight pushes off this joint during toe off at the end of a gait cycle.  As the arthritic process continues, motion becomes more and more limited, making walking difficult and painful.

Etiology

Hallux Limitus/Rigidus usually occurs in adults between the ages of 30 and older. It may result from previous injury to the joint cartilage or abnormal foot mechanics that increases pressure on the joint. Hallux Limitus is used to describe the disease in its earlier stages and Hallux Rigidus describes the later stages. Other causes may include metabolic bone diseases such as chronic gout and other inflammatory arthritic processes.

Signs and Symptoms

• Stiffness in the great toe with an inability to dorsiflex or plantarflex the 1st MPJ.
• An enlargement that develops overlying the joint.
• Swelling around the joint
• Pain in the joint when you are active, especially as you push-off on the toes when you walk.

Diagnosis

Inability to move the big toe joint up and down without pain is the early sign of Hallux Limitus.
X-rays of the foot are used to determine the extent of arthritis.

Conservative Treatment

Pain relievers and/or anti-inflammatory medications may help to reduce any swelling and pain. Steroid injection also may be utilized for short-term relief. Wearing a stiff soled shoe with a rocker bottom design or possibly a steel shank or metal brace in the sole may also be of benefit although we feel an orthotic with a correction under the metatarso-phalangeal  joint, reduces the amount of bending of the joint thereby reducing pain.

When there is damage to the cartilage and conservative care has failed, surgical correction may be performed.

Surgical Treatment

Cheilectomy 

This surgery is recommended when the there is mild to moderate damage to the cartilage. The bone spurs as well as part of the joint bone are removed and smoothed out so that the toe can bend easier. The incision is made on top of the foot, a wooden-soled shoe is worn for at least 2 weeks after surgery, and it is usually 3-4 weeks before a soft shoe may be worn. The toe may remain swollen for several months after the surgery. Most patients do experience long-term relief.

Metatarsal Osteotomy

This procedure is recommended when there is limitation of motion secondary to a plantarflexed 1st metatarsal and the cartilage is in relatively good condition.

The procedure involves an osteotomy of the first metatarsal to shorten the bone (creating more joint space) and rotating the cartilage (to allow more motion).

The patient is in a wooden-soled shoe for 2-3 weeks. After that time, the patient is allowed to get into a soft shoe and is sent for physical therapy to help create more flexibility in the joint. They are usually back to reasonable shoes in approximately 8-10 weeks.                  

Arthrodesis (Fusion )

This surgery is a very old orthopedic procedure reserved for severe damage to the cartilage. This is a fusion of the proximal phalanx and 1st metatarsal. This procedure will prevent the toe from ever bending but does relieve the pain in these most severe cases.

Most patients are in a rigid-soled shoe for approximately 3 weeks. Then they are able to get into a softer shoe and after approximately 8-10 weeks may get into their normal shoes.

Arthroplasty (Joint Replacement )

This surgery is recommended to replace the arthrodesis in moderate to severe damage to the joint. This involves removal of the damaged bone and cartilage of one or both surfaces of the joint and replacing them with a metal or plastic implant. We have found that using a titanium implant has proven to be superior to the older designs. The procedure does not require a cast and patients can usually wear a surgical shoe for 2-4 weeks followed by a softer shoe. Patients may then be referred for physical therapy to increase joint motion, and then may return to their own shoes in approximately 2 months.

Crush Injury to the Foot.

CRUSH INJURY: FOOT 

You have a CRUSH INJURY of your FOOT. This causes local pain, swelling and sometimes bruising. There are no broken bones. This injury takes from a few days to a few weeks to heal. If the TOENAIL has been severely injured, it may fall off in 1-2 weeks. A new one will usually start to grow back within a month.

HOME CARE:

• You may be given a splint, cast, shoe or boot to prevent movement at the injury. Unless you were told otherwise, use crutches or a walker and do not bear weight on the injured foot until cleared by your Podiatrist to do so. (Crutches and walkers can be rented at many pharmacies and surgical/orthopedic supply stores). Do not put weight on a splint; it will break.
• Keep your leg elevated to reduce pain and swelling. When sleeping, place a pillow under the injured leg. When sitting, support the injured leg so it is level with your waist. This is very important during the first 48 hours.
• Apply an ice pack (ice cubes in a plastic bag, wrapped in a towel) over the injured area for 20 minutes every 1-2 hours the first day for pain relief. Continue this 3-4 times a day until the pain and swelling goes away.
• You may use acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) to control pain, unless another pain medicine was prescribed. [ NOTE : If you have chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding, talk with your Podiatrist at Advanced Foot & Ankle Center  before using these medicines.]
• Keep the splint/cast/boot/shoe dry. When bathing, protect it with a large plastic bag, rubber-banded at the top end. If a fiberglass splint/cast or boot gets wet, you can dry it with a hair-dryer. Unless told otherwise, you can remove a boot or shoe to bathe.
• If your injury includes exposed cuts or scrapes, clean these daily with soap and water. Apply Bacitracin or other antibiotic ointment. Watch for the signs of infection listed below.

FOLLOW UP with your Podiatrist as advised. Return sooner if you are not starting to improve within the next THREE days. If you were given a splint, it may be changed to a cast or boot at your follow-up visit.

[NOTE: X-rays will be reviewed by a radiologist. You will be notified of any new findings that may affect your care.]

GET PROMPT MEDICAL ATTENTION if any of the following occur:

• The plaster cast or splint becomes wet or soft
• The fiberglass cast or splint remains wet for more than 24 hours
• Increased tightness or pain under the cast or splint
• Toes become swollen, cold, blue, numb or tingly
• Redness, warmth, swelling, drainage from the wound, or foul odor from a cast or splint
• Fever of 100.4ºF (38ºC) or higher, or as directed by your healthcare provider