What is plantar fasciitis. How does it feel. What are the stages of plantar fasciitis. How is it diagnosed. What are the best treatment options. How can you prevent recurrence. Why are heel spurs often misdiagnosed.

Understanding Plantar Fasciitis: The Root Cause of Heel Pain

Plantar fasciitis is a common inflammatory condition affecting the plantar fascia, a thick band of tissue that runs along the bottom of the foot. This condition is characterized by heel pain and can significantly impact daily activities. To comprehend plantar fasciitis better, it’s crucial to understand its underlying mechanisms and how it develops.

The plantar fascia plays a vital role in supporting the arch of the foot and absorbing shock during walking and running. When this tissue becomes inflamed or irritated, it can lead to pain and discomfort, particularly in the heel area. Contrary to popular belief, heel spurs are not the primary cause of pain in most cases. Instead, the inflammation of the plantar fascia itself is the main culprit.

What causes plantar fasciitis?

Several factors can contribute to the development of plantar fasciitis:

• Overuse or excessive stress on the feet
• Tight calf muscles or Achilles tendon
• Improper footwear
• Sudden increase in physical activity
• Obesity or rapid weight gain
• High arches or flat feet
• Age-related degeneration of the plantar fascia

Understanding these risk factors can help in prevention and early intervention, potentially reducing the severity and duration of symptoms.

Recognizing the Symptoms: How Plantar Fasciitis Manifests

Identifying the symptoms of plantar fasciitis is crucial for early diagnosis and treatment. The condition often presents with distinct characteristics that can help differentiate it from other foot-related issues.

What are the primary symptoms of plantar fasciitis?

The most common symptoms include:

• Sharp, stabbing pain in the heel, especially with the first steps in the morning
• Pain that worsens after prolonged standing or sitting
• Discomfort that may ease during activity but returns after rest
• A sensation of tightness or pulling in the arch of the foot
• Occasional arch pain or discomfort

It’s important to note that symptoms can vary in intensity and may fluctuate throughout the day. Some individuals may experience periods of relief followed by sudden flare-ups.

The Evolution of Plantar Fasciitis: From Early Stages to Chronic Condition

Plantar fasciitis can progress through several stages, each with its own set of symptoms and challenges. Understanding this progression can help in tailoring treatment approaches and setting realistic expectations for recovery.

How does plantar fasciitis progress over time?

The condition typically evolves as follows:

1. Initial Stage: Mild discomfort or a dull ache in the heel, often described as a “stone bruise” sensation.
2. Acute Stage: Sharp, stabbing pain in the heel, particularly intense in the morning or after periods of rest.
3. Chronic Stage: Persistent pain that may become more generalized across the foot, potentially affecting daily activities.

Early intervention is key to preventing the progression to chronic stages, which can be more challenging to treat and may lead to long-term foot problems.

Diagnosing Plantar Fasciitis: Ensuring Accurate Assessment

Proper diagnosis of plantar fasciitis is essential for effective treatment. While the condition shares symptoms with other foot ailments, there are specific diagnostic approaches that can help confirm its presence.

How is plantar fasciitis diagnosed?

Diagnosis typically involves:

• Physical examination of the foot, including palpation of the plantar fascia
• Assessment of pain patterns and symptom history
• Evaluation of foot biomechanics and gait analysis
• Imaging studies such as X-rays or ultrasound to rule out other conditions

It’s crucial for healthcare providers to differentiate between plantar fasciitis and other conditions like heel spurs or stress fractures, as treatment approaches may differ.

Effective Treatment Strategies for Plantar Fasciitis

Managing plantar fasciitis often requires a multi-faceted approach, combining various treatment modalities to address both symptoms and underlying causes.

What are the most effective treatments for plantar fasciitis?

Treatment options may include:

• Rest and activity modification
• Stretching exercises for the plantar fascia and calf muscles
• Proper footwear selection and orthotics
• Ice therapy and anti-inflammatory medications
• Night splints to maintain plantar fascia flexibility
• Physical therapy and manual techniques
• Shockwave therapy or other advanced modalities in persistent cases

The effectiveness of treatment can vary among individuals, and a personalized approach is often necessary for optimal results.

Preventing Recurrence: Long-Term Management of Plantar Fasciitis

After successful treatment, preventing the recurrence of plantar fasciitis becomes a priority. Implementing certain lifestyle changes and maintaining good foot health practices can significantly reduce the risk of future flare-ups.

How can you prevent plantar fasciitis from recurring?

Preventive measures may include:

• Regular stretching and strengthening exercises for the feet and calves
• Maintaining a healthy weight to reduce stress on the feet
• Wearing supportive footwear and avoiding prolonged barefoot walking
• Gradually increasing intensity and duration of physical activities
• Using proper technique during sports and exercise
• Addressing any underlying biomechanical issues with orthotics or gait retraining

Consistency in these preventive measures is key to maintaining long-term foot health and avoiding recurrence of plantar fasciitis.

Debunking Myths: The Truth About Heel Spurs and Plantar Fasciitis

There are several misconceptions surrounding plantar fasciitis, particularly regarding the role of heel spurs in causing heel pain. Understanding the true relationship between these conditions is crucial for proper diagnosis and treatment.

Why are heel spurs often misdiagnosed as the cause of heel pain?

Heel spurs, bony outgrowths on the underside of the heel bone, are often visible on X-rays of patients with heel pain. This has led to a common misconception that the spurs themselves are the source of pain. However, research has shown that many people with heel spurs experience no pain at all, while others with severe heel pain may not have any visible spurs.

The confusion arises because heel spurs can form as a result of long-standing plantar fasciitis. The body may produce these bony projections in response to chronic inflammation or tension in the plantar fascia. However, it’s the inflammation of the soft tissue, not the spur itself, that typically causes pain.

Modern understanding in podiatry and sports medicine recognizes that treating the underlying plantar fasciitis is more effective than focusing on heel spurs. This shift in perspective has led to more targeted and successful treatment approaches for heel pain.

Advanced Treatment Options: When Conservative Measures Fall Short

While many cases of plantar fasciitis respond well to conservative treatments, some individuals may require more advanced interventions. Understanding these options can be crucial for those dealing with persistent or severe cases of plantar fasciitis.

What advanced treatments are available for stubborn cases of plantar fasciitis?

For cases that don’t respond to initial treatments, the following options may be considered:

• Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses sound waves to stimulate healing in the plantar fascia.
• Platelet-Rich Plasma (PRP) Injections: This involves injecting a concentration of the patient’s own platelets to accelerate the healing process.
• Custom Orthotics: Precisely fitted shoe inserts can provide targeted support and correct biomechanical issues contributing to plantar fasciitis.
• Minimally Invasive Procedures: In rare cases, techniques like ultrasound-guided needle therapy or small incisions to release tension in the plantar fascia may be recommended.
• Corticosteroid Injections: While controversial due to potential side effects, these injections can provide short-term relief in some cases.

It’s important to note that these advanced treatments should be considered only after thorough evaluation and when conservative measures have been exhausted. The decision to pursue these options should be made in consultation with a qualified healthcare provider, taking into account the individual’s specific condition and overall health status.

The Role of Biomechanics in Plantar Fasciitis

Understanding the biomechanics of the foot is crucial in both the development and treatment of plantar fasciitis. The way an individual walks, runs, and distributes weight across their feet can significantly impact the stress placed on the plantar fascia.

How do biomechanical factors contribute to plantar fasciitis?

Several biomechanical issues can increase the risk of developing plantar fasciitis:

• Overpronation: Excessive inward rolling of the foot during walking or running can strain the plantar fascia.
• High Arches: Rigid, high-arched feet may not absorb shock effectively, leading to increased stress on the plantar fascia.
• Flat Feet: Lack of proper arch support can cause the plantar fascia to stretch excessively.
• Leg Length Discrepancy: Uneven leg lengths can alter gait and weight distribution, potentially leading to plantar fasciitis.
• Tight Achilles Tendon: This can limit ankle flexibility, increasing strain on the plantar fascia during movement.

Addressing these biomechanical factors often plays a key role in successful treatment and prevention of plantar fasciitis. This may involve gait analysis, custom orthotics, or specific exercises to correct imbalances and improve foot function.

Lifestyle Modifications for Managing Plantar Fasciitis

While medical treatments are often necessary for plantar fasciitis, lifestyle modifications can play a significant role in managing symptoms and promoting healing. These changes can complement other treatments and contribute to long-term foot health.

What lifestyle changes can help manage plantar fasciitis?

Consider implementing the following modifications:

• Weight Management: Maintaining a healthy weight reduces stress on the feet and can alleviate symptoms.
• Footwear Choices: Opt for shoes with good arch support and cushioning, avoiding flat shoes or high heels.
• Activity Modification: Temporarily reduce high-impact activities and incorporate low-impact exercises like swimming or cycling.
• Workplace Ergonomics: Use supportive mats if standing for long periods and take regular breaks to stretch.
• Sleep Position: Use a night splint or avoid pointing toes while sleeping to prevent morning stiffness.
• Foot Care Routine: Implement regular foot massages and use of ice packs to manage inflammation.

These lifestyle adjustments, when combined with proper medical care, can significantly improve outcomes for individuals dealing with plantar fasciitis. It’s important to maintain these habits even after symptoms improve to prevent recurrence.

The Impact of Plantar Fasciitis on Daily Life and Mental Health

Plantar fasciitis can have far-reaching effects beyond physical discomfort. The chronic nature of the condition and its impact on mobility can significantly affect an individual’s quality of life and mental well-being.

How does plantar fasciitis affect daily activities and mental health?

The condition can lead to various challenges:

• Reduced Physical Activity: Pain may limit participation in sports, exercise, or even daily walking, potentially leading to decreased fitness and weight gain.
• Work Interference: Jobs requiring prolonged standing or walking can become difficult, potentially affecting job performance or necessitating time off.
• Sleep Disturbances: Night pain or discomfort can disrupt sleep patterns, leading to fatigue and irritability.
• Social Isolation: Inability to participate in social activities or hobbies can lead to feelings of isolation or depression.
• Anxiety: Worries about pain or potential limitations can cause anxiety, especially in athletic individuals.
• Frustration and Mood Changes: Chronic pain and reduced mobility can lead to mood swings and overall frustration.

Addressing these psychological and social aspects is crucial for comprehensive management of plantar fasciitis. Support groups, counseling, or mindfulness techniques may be beneficial alongside physical treatments. Healthcare providers should consider the holistic impact of the condition when developing treatment plans.

Emerging Research and Future Directions in Plantar Fasciitis Treatment

The field of plantar fasciitis treatment is continually evolving, with ongoing research offering new insights and potential therapies. Staying informed about these developments can provide hope for improved management strategies and more effective treatments in the future.

What new treatments or research directions are emerging for plantar fasciitis?

Several promising areas of research include:

• Regenerative Medicine: Stem cell therapy and growth factor injections are being explored for their potential to accelerate healing of the plantar fascia.
• Advanced Imaging Techniques: High-resolution ultrasound and MRI studies are improving our understanding of the condition’s pathophysiology and guiding more targeted treatments.
• Wearable Technology: Smart insoles and sensors are being developed to provide real-time feedback on foot mechanics and guide personalized treatment plans.
• Genetic Studies: Research into genetic factors that may predispose individuals to plantar fasciitis could lead to more tailored prevention strategies.
• Novel Drug Therapies: New anti-inflammatory medications and topical treatments are being investigated for more effective pain management.
• Biomechanical Modeling: Advanced computer modeling of foot mechanics is enhancing our understanding of stress distribution and informing better orthotic designs.

While many of these approaches are still in experimental stages, they represent exciting possibilities for the future of plantar fasciitis treatment. Patients and healthcare providers should stay informed about these developments, as they may offer new options for those struggling with persistent cases of plantar fasciitis.

Suffering With Plantar Fasciitis | Heel Pain Symptoms & Treatment

Are you suffering from heel pain? It might be caused by plantar fasciitis. Our sports injury clinic specialises in the diagnosis and treatment of plantar fasciitis.

WHAT IS PLANTAR FASCIITIS?

Plantar fasciitis is a painful inflammatory heel condition affecting the large ligament-type structure in the base of the foot that can cause arch pain and heel pain. The plantar fascia can become thick and inflamed due to the irritation at its attachment, at the base of the heel bone. In some patients, small tears can develop and these people suffer from acute pain that can be excruciating. Sometimes, on x-ray, heel spurs (bone spurs) can be seen, but these are not usually the cause of the patient’s heel pain.

It should be noted that “heel spurs” is a misleading diagnosis and treatment for heel spurs has been used by podiatrists and doctors for many years. More and more practitioners today are open to the fact that heel spurs are not the problem and that these bone spurs don’t cause pain. Instead, the source of pain is the inflammation within the plantar fascia surrounding the spur itself.

A online treatment plan by Dr. Karl Lockett from Sydney Heel Pain Clinic

Learn how to treat Plantar fasciitis and heel pain with a treatment plan that allows you to take home Karl’s clinical experience and resolve this condition in the comfort of your own home.

Course Outline

U1. Introduction / condition overview
U2. Causes of Plantar Fasciitis
U3. The big red flags

U3.1. Widespread misinformation
U3.2. Why certain exercises prolong the condition
U3.3. Self treatments to avoid
U4. Treatment and clinical advice
U4.1. Unloading the Plantar Fascia
U4.1.1. Dr. Karl’s favourite strapping technique
U4.1.2. Selecting the perfect shoe
U4.2. The Super Stretch (Release the heel)
U4.3. Reduce irritation / accelerate healing
U5. Final steps
U5.1. How to prevent a recurrence
U5.2. Ongoing heel care

Disclaimer: The clinical advice in this video provides the fundamentals and the foundations of all plantar fasciitis treatment plans, recommended by Dr. Karl Lockett in his practice. Please note some patients also enjoy the benefits of additional treatments such as shockwave therapy and customised orthotics.

Dr Karl Lockett is not liable for your foot and ankle condition without consultation and informed consent.

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What Does it Feel Like?

Patients with plantar fasciitis usually feel pain under the ball of the heel and it can represent a stone bruise sensation. Arch pain is less common but is also a key symptom of the condition. The heel pain is common first thing in the morning when climbing out of bed and after periods of rest, such as driving or being seated. The pain in the heel can be erratic and often, there are pain-free periods when the person feels like they are healing. If there is a very sudden onset of pain, as opposed to a gradual onset, this may be due to tearing of the plantar fascia.

Correct Diagnosis

It is important that the podiatrist differentiates between regular plantar fasciitis, and plantar fascia tearing as the treatment is different. Your podiatrist will also be able to exclude the possibility of a stress fracture, which sometimes leads to similar symptoms. Ultrasound imaging may be necessary to accurately diagnose the cause of the patient’s heel pain.

At Sydney Heel Pain, our podiatrists are highly experienced and skilled in the diagnosis and treatment of heel pain.

THE STAGES OF PLANTAR FASCIITIS

INITIAL STAGES OF PLANTAR FASCIITIS

Initially, these heel pain patients may feel a dull ache in the base of the heel. There may be an awareness of a problem in the afternoons, or after they have been weight-bearing for long periods of time. It is possible that they feel some pulling in the plantar fascia, which they describe as a tightness in the arch or the sole of the foot.

Early treatment or intervention at this stage is crucial and may inhibit the development of a more chronic heel pain condition. Unfortunately, many patients ignore the early symptoms, presuming or hoping that the tightness or the dull ache in the heel will settle down and dissipate. In some people, this is the case, but others can develop severe heel pain and/or chronic P.F.

As sports podiatrists, the typical symptoms that we hear in these early stages, are the feeling of a pebble in the shoe or a stone bruise sensation. Patients with mild P.F sometimes inform us that they felt like they had stepped on a small pebble or stone.

In these early stages that we describe above, the condition does not always induce heel pain throughout the daytime. The symptoms may only be present in the morning when getting out of bed and can be very sporadic. Some patients are asymptomatic for a day or two only to find the pain returning.

In the early stages, there can also be some heel pain in the morning when the foot hits the floor, but this is usually mild and is often little more than a feeling of tightness.

CHRONIC PLANTAR FASCIITIS

When the condition is fully developed, the symptoms of plantar fasciitis heel pain are more acute. The condition will become chronic if the strain on the plantar fascia goes on for long enough and remains untreated.

The pain in the heel is more consistent and patients will usually report pain, not just stiffness, each morning when hopping out of bed. Most patients hobble for at least 5 minutes after getting out of bed due to extreme plantar fasciitis heel pain.

The pain in the heel usually subsides within 15 minutes and patients are usually more comfortable after taking a hot shower. Walking throughout the day isn’t always a problem as the inflammatory change in the plantar fascia is less consistent and the heel pain isn’t always present.

However, mid-afternoon, after several thousand steps the foot fatigues, and the heel pain returns. Patients will sometimes report pain when getting out of their car after a drive home from work. They hobble again for the first few minutes and find some relief after walking a short distance.

Podiatrists are often informed by their patients that they also limp when they stand up after being seated for dinner in the evenings or after sitting on the couch watching television. An ultrasound report will often show thickening of the plantar fascia, due to inflammatory change.

SEVERE PLANTAR FASCIITIS

If the condition comes on very quickly, during a one-off event or during a particular day/activity then the pain can feel severe/acute. Alternatively, chronic plantar fasciitis left untreated can lead to the same state.

Acute Inflammation

In these cases, the strain on the plantar fascia has been so great and so repetitive that acute inflammation develops as does extreme pain. Patients with severe P.F will usually describe to the sports podiatrist an extreme level of pain that is present for most of the day. These patients will experience throbbing when sitting or lying down and are starting to feel the psychological effects of having a condition that is both chronic and acute.

Often described as “excruciating” or “relentless”, heel pain plantar fasciitis patients experience symptoms that affect their daily lives, as they stop exercising and are often struggling to walk during day-to-day movements.

Some patients with severe P.F have developed deep surface or laminar tears in the fascia. As sports podiatrists, we arrange ultrasound scans, to help confirm or exclude torn fascia. X-rays are less helpful in the case of this soft tissue injury.

WHO SUFFERS FROM PLANTAR FASCIITIS HEEL PAIN?

Adults

Plantar fasciitis can affect men and women equally, but there is a trend in terms of the age of the patients that we treat. Fewer people younger than 30 years of age develop the condition, and the majority of patients are over 60. In between those ages, there is a large percentage of male and female patients in their 40’s and 50’s.

Sedentary people who haven’t exercised for some time, who enter a get fit health program of sorts, and those who join a boot camp, will often develop pain in the heel or Achilles tendon, namely plantar fasciitis, Achilles Tendonitis, or Bursitis.

Children

Occasionally we see juvenile-onset P.F which affects children who are engaged in sport and physical activity. It is important that we differentiate between other heel pain conditions such as Severs disease and Achilles Tendonitis.

Experienced Sports Podiatrists

Our sports podiatrists have extensive experience in these conditions as well as treatment for Achilles Tendonitis & Severs disease. We can determine which one your child has, by carrying out a careful physical examination. We will refer for x-ray or ultrasound scans if we deem them necessary.

CAUSES OF PLANTAR FASCIITIS

Multifactorial Causes

There is no single cause of plantar fasciitis. The cause is multifactorial, as is the plantar fasciitis treatment. Ultimately, there is an increased load on the plantar fascia which causes it to become pathological. Tight calf muscles and soft shoes are a big problem, as are flat feet and an increase in body weight. Biomechanical issues leading to poor foot function can also trigger the condition. Patients who suddenly increase the amount or frequency of sporting activity/exercise are also at risk.

We often hear patients saying, “I was looking to get fit after Christmas and was training several times a week, and then my heel became extremely painful…”

PLANTAR FASCIITIS TREATMENT

At Sydney Heel Pain, our objective is to provide a long-term solution to your heel pain condition, and not just quick pain relief. Our sports podiatrists have a wealth of experience in heel pain treatment and treating plantar fasciitis, as well as all other types of painful heel conditions.

Karl will select an appropriate combination of one or more treatments to suit the severity of your plantar fasciitis and your lifestyle.

Some common treatments may include:

• Extracorporeal shockwave therapy with strapping
• Use of an immobilisation boot
• Footwear changes/recommendations with strapping and stretching
• Custom-tailored prescription orthotics (gentle arches) with shockwave therapy.

Our team uses custom orthotics for plantar fasciitis that are specifically designed as to not push upwards against the plantar fascia. Although going against the grain of the traditional arch support theory (old science) our orthotics unload and support the plantar fascia so that injections and medications are not required, allowing the foot to heal naturally.

You can find out more about our orthotic inserts for plantar fasciitis treatment on our blog.

Written by Karl Lockett

Relevant information about plantar fasciitis:

https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846
https://www.health.harvard.edu/newsletter_article/easing_the_pain_of_plantar_fasciitis
https://www.webmd.com/fitness-exercise/understanding-plantar-fasciitis-basics

Plantar Fasciitis Los Angeles | Stabbing Pain

The plantar fascia is a long, thin ligament present along the bottom of the foot that creates the arch of the foot. It extends from the heel bone, and then splits and fans out to attach itself to the toes.

Plantar fasciitis is a condition where the plantar fascia becomes inflamed from overstretching or overuse, causing pain in the heel and bottom of the foot. It can occur in one or both feet due to excessive standing and is one of the most common orthopaedic complaints, especially in active men between 40 and 70 years of age.

Causes

Plantar fasciitis occurs when you strain or irritate the plantar fascia ligament. Repeated strain can result in tiny tears in the ligament, leading to pain and swelling, which can make walking difficult.

Strains can occur due to :

• High or low foot arch
• Obesity or sudden weight gain
• Tight Achilles tendon which connects the calf muscles to the heel
• Starting a new activity or increasing the intensity of an activity
• Wearing improper shoes with soles that are too soft, do not fit well or offer poor arch support

Symptoms

The major complaint of plantar fasciitis is pain and stiffness in the heel and foot. The pain associated with this condition becomes more intense:

• In the morning when you step out of bed
• Walking after sitting or standing for some time
• Climbing stairs
• After exercise

Diagnosis

Your doctor diagnoses plantar fasciitis after reviewing your medical history and conducting a physical examination of the foot to check for tenderness, stiffness or redness of the sole. Your doctor may watch how you stand and walk, and evaluate related conditions such as high arches.

X-rays of the foot can be taken if your doctor suspects a stress fracture, a hairline fracture in the bone, or other related conditions such as a heel spur, which is extra calcium deposit on the heel bone.

Treatment

Treatment involves conservative measures to resolve the condition. Conservative treatment measures include:

Rest: Rest is the first step that is considered for reducing pain and preventing further damage to the ligament.

Ice: Rolling your foot over ice can be very effective in reducing swelling, and is recommended for 20 minutes, 3-4 times a day

Medications: NSAIDs (non-steroidal anti-inflammatory drugs) may be prescribed for relief of pain and inflammation

Exercise: calf stretches and plantar fascia stretches are effective in relieving pain
A steroid injection may be administered into the plantar fascia for reducing pain and inflammation
Supportive shoes and orthotics may also be recommended to reduce the pain while walking or standing
Night splints can be suggested by your doctor to help stretch the plantar fascia while sleeping
Physical therapy may be recommended for instruction on stretching exercises, massage and ice treatments
PT may use extracorporeal shockwave therapy (ESWT), which uses high-energy shockwave impulses to stimulate healing of the
damaged plantar fascia tissues

Surgery

Surgical treatment is considered only if conservative therapy does not provide effective relief after 12 months.  There are two surgeries your surgeon may perform and will depend on your particular situation.

Gastrocnemius recession- Tight calf muscles or gastrocnemius muscles can strain the plantar fascia. To release this stress, your surgeon will surgically lengthen the calf muscle, and increase the motion of the ankle. The surgery can be performed by open incision or endoscopically through a small incision by using an endoscope, which is a long instrument with a small camera attached.

Plantar fascia release- If you have normal range of ankle motion, but continue to have heel pain, a partial release procedure is recommended. Your surgeon will partially cut the plantar fascia ligament to relieve the tension. The surgery can be performed endoscopically but open incision is easier to perform and is associated with lower risk of nerve damage.

Risks and Complications

Complications are rare following surgery to treat plantar fasciitis, but as with any surgical procedure, they can occur.  Some complications include:

• Infection
• Nerve Damage
• Unresolved Pain

Pain in the feet when walking: an orthopedist explained what could be the cause

• Health

Pain in the feet is a very common problem. Orthopedists can tell you about two dozen reasons for this condition. We will discuss the most common causes of foot pain, symptoms, and treatments.

June 2, 2022

Source:

iStockphoto

Foot pain is always unpleasant. It interferes with the usual life, not allowing you to move freely. There are a great many reasons for the development of pain, and their search can be a serious problem. The history of the disease and certain symptoms of foot problems can give us valuable clues, but they may not be enough to make an accurate diagnosis.

“Doctor Peter” found out from Ilya Volodin, a traumatologist-orthopedist, podiatrist, member of the AOTrauma association, assistant of the Department of Traumatology, Orthopedics and Military Surgery, VolgGMU, which of the causes most often provoke pain and problems with walking, as well as pain at rest.

Transverse flatfoot with metatarsalgia

Metatarsalgia is a term for pain in the forefoot that occurs at the base of the toes. It develops when the transverse arch of the foot – the elevation from the 1st toe to the 5th metatarsus – flattens and the load on the forefoot begins to be distributed incorrectly, which leads to pain.

Symptoms

People with this disease feel acute pain under the base of the toes. Sometimes this pain can be compared to the sensation of stepping on a stone. It is usually relieved when the person sits or lies down. Walking barefoot worsens.

Causes

Most often, this problem is associated with abnormal biomechanics of the foot or excessive loads on the legs. The elderly, overweight people, and runners may also be at higher risk of developing metatarsalgia.

Treatment

Foot exercises, modification of physical activity and fitting of orthopedic insoles often solve this problem. Surgery may be an option if other treatments fail to provide relief.

See also

Morton’s neuroma

Another common foot problem is Morton’s neuroma. It causes sharp or burning pain between the metatarsal bones that radiates to the fingers. Many people describe the sensation as walking on rocks with bare feet or having a rock in their shoes. The very definition of a neuroma is a benign (non-cancerous) thickening of the nerve that goes to the toes.

Symptoms

Shooting or burning pain in the area of ​​the transverse arch of the foot (between the metatarsal bones) can spread between two fingers. Most often it is felt between the third and fourth fingers. The fingers themselves may become numb, pain occurs, which increases with physical activity or when wearing shoes, after removing the shoes, the pain subsides.

Causes

The cause of Morton’s neuroma is not fully understood. It is believed that certain factors, such as flat feet or wearing tight, narrow shoes, high heels, can lead to increased pressure on the nerve and changes in it. Diagnosis is based on a physical examination, as well as ultrasound or MRI.

Treatment

Orthopedic insoles with a metatarsal pad reduce pressure on the metatarsal bones and may relieve pain from Morton’s neuroma. Loose, wide-toe shoes that allow the toes to feel more comfortable can help. Sometimes, if the pain persists, the podiatrist may locally inject a corticosteroid into the area of ​​the neuroma. If the above simple methods do not bring relief, the last option is surgery. A small part of the affected nerve is removed with excision of the tissue that surrounds it.

See also

Achilles tendonitis

The Achilles tendon at the point of attachment to the heel bone can experience increased stress, which leads to tendinitis. The term “Achilles tendonitis” refers to inflammation of the Achilles tendon, which can be chronic and long-term.

Symptoms

This condition causes aching or burning pain with exertion or strain. An inflamed tendon is usually painful to the touch. There may also be slight swelling over the tendon, fever, and a change in the shape of the heel.

Causes

Several factors can contribute to Achilles tendinitis. They include:

• Sudden increase in training load

• Calf strain

• Wearing the wrong shoes

• Cold weather training

• Flat feet

• Differences in leg length

Treatment

Usually a combination of treatments:

1. Acute RICE protocol (rest, ice to the site of inflammation, compression – application of an elastic bandage on the foot and ankle joint, elevated position of the foot)

2. Taking NSAIDs as prescribed by a doctor.

As soon as the acute pain subsides, it is recommended to choose an exercise therapy program with a doctor, undergo physiotherapy, and make individual orthopedic insoles. If conservative therapy fails or the Achilles tendon ruptures, surgery may be required.

See also

Osteoarthritis of the joints of the foot

Osteoarthritis occurs when the cartilage in a joint thins and breaks down as a result of physical wear and tear. This leads to a decrease in the interarticular gap, compaction of the bone under the cartilage and bony growths around the joint. Often, pain and lack of mobility in osteoarthritis of the joints of the foot are found in the ankle joint, subtalar joint, and joint of the big toe.

Symptoms of OA may include:

1. Pain at rest and on movement.

2. Joint limitation.

3. Crunching and “rubbing” sensation when moving the joint.

4. Swelling that usually gets worse with exercise.

Causes

As you age, the cartilage in your joint naturally wears and thins. A family history of osteoarthritis and being overweight can also increase the risk of developing OA.

Treatment

Osteoarthritis of the foot is initially treated with simple measures.

• Lifestyle changes such as weight loss and exercise.

• Taking NSAIDs

• Physiotherapy

• Wearing custom orthotic insoles to reduce pain.

• Use of a cane for ease of movement.

Arthroscopy – Joint fusion or replacement surgery is considered if pain persists or interferes with daily activities.

Text author: Alena Paretskaya

Peripheral neuropathy after chemotherapy – together by St. Jude

Chemotherapy-induced peripheral neuropathy is nerve damage that can develop as a side effect of chemotherapy. Symptoms include pain, numbness, or tingling in the hands or feet. As the condition progresses, weakness in the feet or hands may develop. A child may have a change in gait due to an inability to lift the forefoot, a condition known as foot drop. Peripheral neuropathy usually regresses after chemotherapy because the nerves have the ability to heal. However, the symptoms may not completely disappear, and new symptoms may also develop (the so-called long-term effects of therapy).

There are several treatments for peripheral neuropathy. Your doctor may prescribe medication to relieve pain. Physiotherapy and occupational therapy also help patients cope with physical limitations due to pain, loss of sensation, and muscle weakness.

Symptoms of peripheral neuropathy

The specific symptoms of peripheral neuropathy depend on which nerves are affected and how severely. Possible symptoms include:

Loss of sensation

• Numbness (loss of sensation), tingling or burning sensation, usually in the hands or feet
• Pain in the mouth or lower jaw
• Sensitivity to touch or heat/cold
• Sharp, sudden, shooting pain

Movement symptoms

• Loss of balance or coordination
• Change in gait or manner of walking that may lead to trips or falls
• Reduced reflexes
• Muscle weakness or loss of muscle mass (legs appear thinner), especially in arms and legs
• Muscle cramps
• Fine motor problems (eg, difficulty writing, tying shoelaces or buttoning)

Autonomic symptoms

• Constipation or difficulty urinating
• Reduced perspiration
• Changes in blood pressure

The disorders begin with the nerve endings located farthest from the spinal cord. That is why the hands and feet are most often affected, and weakness often develops first in the legs and only then in the arms.

Causes of peripheral neuropathy

Peripheral nerves transmit signals from the brain to parts of the body and back. These signals can have various functions, including motor (movement), sensory (pain, touch), or autonomic (blood pressure, temperature).

Chemotherapy drugs can affect these nerves. The most dangerous drugs for the treatment of childhood cancer are:

• Vincristine
• Vinblastine
• Cisplatin
• Carboplatin
• Bortezomib
• Thalidomide

Higher doses and drug combinations may increase the chance of developing neuropathy. Young children can be especially vulnerable as their nervous systems are still in the process of developing. Radiation therapy and diseases such as diabetes can also cause nerve damage and increase the risk of developing peripheral neuropathy with chemotherapy.

Diagnosis of peripheral neuropathy

In general, the following factors are taken into account in the diagnosis of peripheral neuropathy:

• Character of symptoms (sensory, motor, autonomic, or combination)
• Severity of symptoms (pain, degree of impact on daily life)
• Dynamics of symptoms over time (progressive or stable)

Patients with symptoms of peripheral neuropathy may be referred to a neurologist for additional evaluation. As part of a neurological examination, an assessment of reflexes, sensitivity and nerve signals (their conduct) is carried out. Based on the data obtained, the doctor can determine the degree – or measure the severity – of nerve damage.

In addition, a physiotherapist may perform an examination to evaluate the following parameters:

• Muscle strength
• Range of motion in joints
• Foot and ankle position in sitting and standing positions
• Balance
• Walking barefoot for gait and foot position assessment
• Ability to sense touch and vibration
• Reflexes

Information obtained from the patient, family and members of the treatment team helps determine the next steps in treatment.

Prevention and treatment of chemotherapy-induced peripheral neuropathy

When planning chemotherapy and supportive care, physicians consider the possibility of reducing the risk of nerve damage while maintaining the effectiveness of anticancer treatment. Various studies are currently underway on drugs and medical interventions that can be used to protect nerves from the toxic effects of chemotherapy. If possible, the doctor will try to reduce the dose of drugs, schedule breaks, or avoid combinations of drugs that increase the risk of neuropathy.

The current treatment of peripheral neuropathy focuses on symptomatic relief. Treatment includes:

• Pain relief – Various types of drugs can be used to treat neuropathic pain, including antidepressants, anticonvulsants (such as gabapentin), and pain relievers (such as opioid analgesics or lidocaine).
• Rehabilitation support – physiotherapy and occupational therapy are independent methods of treatment, and are also used as auxiliary methods. Specific treatments are listed below:
  • Exercises to increase strength, range of motion and improve balance
  • Walking aids (walkers, crutches or canes)
  • Orthopedic appliances, including arch or ankle orthoses, to allow for joint positioning and proper function
  • Assistive devices for daily activities, including devices to assist with writing, buttoning clothes, or brushing teeth
  • Light electrical stimulation of weakened muscles (requires physician approval as this technique may be contraindicated during cancer treatment)
  • Home exercise and family education
• Complementary therapies – Patient may benefit from psychosomatic therapies (eg, massage, acupuncture, biofeedback, and relaxation techniques). Before using any new therapies, the patient’s family should consult with their physician to ensure they are safe.
• Chemotherapy adjustments – in the case of severe peripheral neuropathy, the treatment team may recommend changing the chemotherapy plan to reduce drug exposure. Such decisions should be made taking into account the risks to the health of patients in general.

Long-term effects of chemotherapy-induced peripheral neuropathy

Muscle weakness, gait changes, and joint instability can lead to long-term problems in childhood cancer survivors. If the joints and muscles don’t work properly, damage to the knees, hips, and spine can occur over time. This causes pain and loss of function in various parts of the body, and increases the risk of falls. Pain and limited mobility can adversely affect work ability and family life. Peripheral neuropathy often leads to reduced physical activity, which can lead to other health problems.

For survivors of childhood cancer, treatment of peripheral neuropathy and regular monitoring of symptoms are essential for future health and quality of life.

Family Advice

• Wear shoes that provide support without being too tight. Choose shoes with rubber soles and avoid shoes that are easy to slip or fall in.